Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, multifragmentary

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Glossary

General considerations

These are extremely unstable fractures, for which open reduction and internal fixation are strongly indicated.

Associated neurovascular compromise must be excluded. If present, prompt surgical intervention is mandatory.

Pediatric fractures are considered in Pediatric trauma of Surgery Reference.

Nonoperative treatment
Indication summary Skill Equipment
Minimally displaced or patient not fit for surgery Some specialized surgical experience Basic equipment only

Indications

Nonoperative treatment is indicated if all four of the following criteria are met:

  • Isolated injury
  • Closed fracture
  • Cooperative patient
  • Acceptable alignment

Contraindications

  • Noncompliant patient
  • Polytrauma patient
  • Open fracture
  • Additional ipsilateral fracture
  • Displacement
  • Nerve interposed in fracture
  • Nerve injury developing with closed treatment

Advantages

  • Noninvasive
  • Inexpensive
  • Delayed surgery possible

Disadvantages

  • Requires patient cooperation
  • Marked patient discomfort
  • Close monitoring of fracture position required
  • Immobilization
  • Subsequent joint stiffness
External fixation
Indication summary Skill Equipment
Severe open fractures. Unstable fracture. Unstable patient. Usually preliminary treatment Highly experienced and skilled surgeon Simple surgical and imaging resources

External fixation is used in the treatment of distal humeral fractures with extensive soft-tissue damage, severe contamination, infection, and/or major bone loss. It may be used as primary treatment in polytrauma patients.

External fixation is only very rarely used as the definitive treatment in distal humeral fractures.

Further indication

  • Temporary spanning immobilization in fractures with small distal fragments

Contraindication

  • Osteoporosis

Advantage

  • Rapid provisional treatment, especially in polytrauma

Disadvantages

  • Possible loss of fixation
  • Pin-track infection
  • Cumbersome fixation interferes with elbow motion
ORIF - Plate and screw fixation
Indication summary Skill Equipment
Treatment of choice for displaced fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Indications

  • Open fracture
  • Unacceptable displacement or redisplacement
  • Pathological fractures
  • Vascular and/or nerve injury
  • Other injuries of the arm (e.g. floating elbow, associated hand or wrist injury)
  • Nerve entrapment or deficit

Contraindications

  • Unacceptable surgical risk
  • Poor general health status
  • Noncompliant patient
  • Extreme osteoporosis

Advantages

  • More accurate reduction
  • Nerve protection
  • Potentially better fixation
  • Early functional after treatment
  • Reduced risk of joint stiffness
  • Immediate stability

Disadvantages

  • Invasive
  • Risk of infection
  • Requires great surgical skill
  • Requirement for anesthesia
  • Cost
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2007-06-21