Non-operative, conservative management can be considered in stable non-displaced partial articular fractures (Milch type 1) and predominantly in low-demand patients with a high perioperative risk profile 1,2. Conversely, a good or excellent outcome has been shown for surgical fixation in long term follow-ups 1,2,4. The risk of prolonged fracture healing or fracture non-union is up to six times higher with conservative treatment than with surgery. Most distal humeral fractures are managed surgically since prolonged immobilization of one week or longer tends to lead to poor functional outcomes. neurovascular injury)Ī common distal humeral fracture in childhood is the supracondylar fracture. signs of complications if evident (e.g.involvement of the trochlea, the capitellum or both.extra-articular, partial or complete articular.This can be supplemented with 3D images, which has been shown to improve the reliability of fracture characterization and classification 6. The main objective of CT is an improved characterization of the exact fracture morphology. Standard elbow radiographs AP view with the elbow flexed 40° and elbow lateral view with the shoulder abducted and the elbow flexed to 90° each should be obtained. MRI is rarely needed in the acute setting can be helpful in concomitant ligamentous injuries 1. CT can be a helpful adjunct for the characterization of intra-articular fractures and surgical planning 1-4. Plain radiographs are the mainstay of diagnosis of distal humeral fractures. Depending on how they are displaced there may be features of overlay and/or impaction. Radiographic featuresįractures will usually show a radiolucency or cortical breach. Coronal shear fractures can be classified after Bryan and Morrey or Dubberley 1-4. Other classifications are the Milch classification of single columnar articular fractures, which differentiates fractures on whether the lateral trochlear ridge is affected or intact and the Jupiter classifications for bi-columnar articular fractures. the height of the transverse fracture (transcondylar, supracondylar)Ī commonly used classification system of distal humeral fractures, which takes those features into account is the AO/OTA classification 5.the plane of the fracture (sagittal, coronal).the affected distal humeral segments (trochlea, capitellum, epicondyles).number of fragments (simple, fragmentary, multifragmentary).articular involvement (extraarticular, partial articular or complete articular fractures).
#ELBOW HUMERUS FRACTURE FULL#
direct compression of the capitellar articular surface by the radial head either in extension or full flexion – results in an isolated capitellar fractureĭistal humeral fractures can be classified based on the following 5:.indirect valgus or varus trauma in elbow extension – this usually results in a complete articular fracture.direct impaction of the proximal ulna onto the trochlea or the capitellum, with the elbow in a flexed or extended position – this usually results in a complete articular fracture.Typical mechanisms include the following 3: Most distal humeral fractures are a result of a high energy trauma or a fall. Trauma-related complications include the following 1:ĭistal humeral fractures can involve the epicondyles, the trochlea, the capitellum and the metaphysis of the distal humerus or all of those osseous structures. Weakness or paresthesias of the wrist might indicate nerve injury 1. Decreased or abnormal pulses might indicate a concomitant vascular injury. Typical symptoms include pain and swelling of the elbow, instability and functional disability. sports activities with increased risk of high energy trauma.Risk factorsĪttributes, characteristics or activities that increase the likelihood of sustaining a distal humeral fracture include 1-3: Similar to distal femoral fractures they show a bimodal distribution being common in young males and elderly women 1,2. They occur with an incidence of about 5.7/100,000 per year and represent about 30% of all humeral fractures and about 2-6% of all fractures 1-4.
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