Executive Editor: Chris Colton

Authors: Mariusz Bonczar, Daniel Rikli, David Ring

Distal humerus - Extraarticular, simple, oblique

back to skeleton

Glossary

General considerations

These oblique fractures of the distal humeral metaphysis are inherently unstable.

The radial and ulnar nerves are vulnerable to traction injury or entrapment.

Most of these fractures require internal fixation, which sets the scene for early functional rehabilitation.

Any neurological compromise constitutes an even stronger indication for surgical intervention.

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

  • Minimal or no displacement
  • No nerve or vessel injury
  • Unacceptable surgical risk

Contraindications

  • Noncompliant patient
  • Displacement
  • Nerve entrapment

Advantages

  • No scarring
  • No surgical risks

Disadvantages

  • Risk of secondary displacement
  • Immobilization of joint
  • Subsequent stiffness of the joint
  • Patient discomfort
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 fixation
Indication summary Skill Equipment
Majority of displaced fractures. Nerve or vessel injury Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Open fractures
  • Displacement or redisplacement
  • Nerve entrapment
  • Vascular injury
  • Other injuries of the arm (eg, floating elbow; associated hand or wrist injury)
  • Pathological fractures

Contraindications

  • Age
  • Unacceptable surgical risk
  • Noncompliant patient
  • Extreme osteoporosis

Advantages

  • Nerve protection
  • Early functional aftertreatment
  • Reduced risk of joint stiffness
  • More accurate reduction
  • Immediate stability

Disadvantages

  • Risk of infection
  • Requirement for anesthesia
  • Cost
  • Often scar sensitivity
*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