Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, multifragmentary

back to skeleton


Author: Dankward Höntzsch

1 Note on illustrations top


Throughout this treatment option illustrations of generic fracture patterns are shown, as four different types:

A) Unreduced fracture
B) Reduced fracture
C) Fracture reduced and fixed provisionally
D) Fracture fixed definitively

2 Principles of modular external fixation top


The modular external fixator is optimal for temporary use. It is rapidly applied without need for intraoperative x-rays and can be adjusted later.

Details of external fixation are described in the basic technique for application of modular external fixator.

Specific consideration for the distal humerus are given below.

3 Patient preparation top


This procedure is normally performed with the patient in a supine position.

4 Pin insertion (humerus/forearm) top


Pin placement

For safe pin placement make use of the safe zones and be familiar with the anatomy of the humerus and the proximal forearm.


Soft tissue dissection

Blunt dissection of the soft tissues and the use of small Langenbeck retractors will prevent damage to muscular, vascular and neurological structures.

Prepare a channel for insertion of the pin, using a blunt clamp down to the bone. If there is any doubt an incision should be made big enough to prove that the drill sleeve (for the humerus a must) will have direct contact with the bone.

Be especially careful of the radial nerve, which spirals around the humeral shaft and, in the distal third, it intersects the lateral intermuscular septum.

5 Frame construction / reduction and fixation (distal humerus) top


Pearl: non-bridging fixator

If the fracture is far enough from the joint and there is good bone quality, sometimes it is possible to apply the external fixator only to the humerus, leaving the elbow joint free.

v1.0 2007-06-21