A distal humerus fracture is a bone fracture located in the lower end of the upper arm bone (medical term humerus). In children, such fractures are mainly caused by falls with the arm extended, while in adults, falls on the elbow joint are often responsible for distal humerus fractures.
What is a distal humerus fracture?
In a distal humerus fracture, fractures occur in the humerus, and adults and children are affected by the fractures at different rates. In adults, distal humerus fractures account for approximately three percent of all fractures of the extremities, while in children they account for up to ten percent. Thus, overall, distal humerus fractures are a rare form of bone fracture. Distal humerus fractures are difficult fractures to treat. They are clustered in children between the ages of five and ten, accounting for approximately five percent of all fractures, but 80 percent of all childhood fractures of the elbow.
Causes
The possible causes for developing a distal humerus fracture can vary. As is common with fractures that are outside the joint and partial joint fractures, the main causes are a direct or indirect force on the affected bone. Fractures outside the joint (medical term extraarticular fractures) are divided into diverse categories depending on the accident mechanism. These include the more common extension fractures as well as flexion fractures, which occur far less frequently. These occur in the majority of cases in children. If the distal humerus fracture is a complete fracture of the joint, the cause is the direct application of force.
Symptoms, complaints, and signs
In the context of a distal humerus fracture, various symptoms and complaints may arise for the affected patient. First and foremost, individuals suffer from severe pain. The pain originates from the area of the fracture, but radiates and can extend far beyond the upper arm. Under these circumstances, movements of the arm affected by the distal humerus fracture are hardly possible. Furthermore, in addition to pain, there is usually swelling, malalignment, and palpable and audible crepitation. This is the rubbing together of fracture parts, which in most cases is associated with severe pain. In addition, the distal humerus fracture can be associated with further complaints, for example if it has occurred as a result of a fall and further injuries have formed, for example in the form of abrasions or even larger open wounds. Other symptoms that may arise in connection with a distal humerus fracture include, for example, damage to the brachial artery as a result of the extension fractures. In addition, a so-called Volkmann contracture can develop on the flexor side due to a lesion of vessels and nerves. Damage to the ulnar nerve and the radial nerve can also accompany a distal humerus fracture. However, these are only rarely observed.
Diagnosis
Various methods of examination are available for the diagnosis of distal humerus fracture. In most cases, an examination using radiographs is used. The attending physician performs this examination in two planes to analyze the distal humerus fracture from different sides. This diagnostic method is usually sufficient to make a reliable diagnosis as well as to plan a possible operation. For further clinical concerns, it is sufficient to differentiate into some fracture types. A distinction is usually made into three forms, namely fractures affecting the bone (metaphyseal), fractures localized in the joint capsule (intraarticular) or outside the joint (extraarticular). This classification has proven itself over the long term and is used by most physicians. The clinical examination should also include a check of the blood flow, sensibility, and motor function of the affected arm as well as the hands and fingers. Corresponding diagnoses related to the distal humerus fracture are confirmed by means of X-ray images.
Complications
Distal humerus fracture circumscribes a rarely occurring complicated fracture of the lower end of the humerus. These extremity fractures occur predominantly in a fall with the arm extended or on the elbow joint. The symptom is more common in children than in adults. Affected individuals suffer severe pain that extends well above the shoulder. The arm can hardly be moved and has a deformity. Crackling sounds of the fracture parts can be heard on palpation. Furthermore, swelling and hematomas appear, especially if the humeral artery has been injured. If the symptom is not treated as soon as possible, complications increase. Associated symptoms such as severe abrasions or open wounds may become infected. In the flexor side of the arm, nerves and vessels can be permanently damaged. The consequences are circulatory and sensory disturbances, but also permanent motor damage that extends into the fingers. Distal humerus fractures include different types of fractures that can affect one or more bones as well as the joint capsule. Imaging measures clarify the type of fracture for surgical intervention. Surgery for distal humerus fracture is often complicated. The soft tissue mantle must be able to form a new stable connection of the bone structure and a precise joint surface reconstruction must be carried out. Afterward, the patient must undergo physical therapy.
When should you see a doctor?
If a distal humerus fracture is suspected, a physician should be consulted immediately to clarify the symptoms and provide direct treatment if necessary. Anyone who feels severe pain in the upper arm after a fall or accident is best to call an emergency physician directly. Swelling, malpositioning or bleeding also indicate a medical emergency that must be clarified immediately. At the latest, if symptoms of shock are noticed, the emergency number must be dialed immediately. Open abrasions can sometimes be self-cared for. However, due to the risk of infection alone, this task should be left to a medical professional. If nerves or vessels have been injured, this must be treated in hospital in any case. Otherwise, the symptoms will increase and permanent motor damage may occur, which can extend from the shoulder to the fingers. In the case of nerve damage, further physiotherapeutic treatment may be necessary. What specific measures need to be taken to restore the upper arm’s ability to move and perform is best answered by the physician in charge.
Treatment and therapy
Various methods are available for the treatment of a distal humerus fracture. These are used depending on the shape of the fracture and its severity. In the majority of cases, the distal humerus fracture is treated surgically by applying a plate osteosynthesis or, alternatively, a screw osteosynthesis. If the fracture is particularly complex and reconstruction is no longer possible, therapy with an elbow joint prosthesis must be considered in individual cases. Far less frequently, there is the possibility of conservative treatment in the presence of a distal humerus fracture. For this, the fracture fragments must not be displaced from their original position and there must be no instability. Conservative therapy involves the application of a humeral cast for a period of three to six weeks. If children are affected by distal humerus fracture, the prognosis is usually good.
Outlook and prognosis
Distal humerus fracture heals well in most cases. Children have the best prognosis prospects in this regard and can often be free of symptoms for life after healing. The older the patient, the worse the fracture heals. The healing process is prolonged overall and there are often restrictions on movement. In children, complications and secondary damage can occur if the growth plate is affected in the distal humerus fracture. This leads to problems with reduction and can negatively affect the very favorable prognosis. Adults suffer more from permanent mobility restrictions because the bones no longer grow together in their natural shape with increasing age. In addition to mobility restrictions, a loss of the usual level of performance or weather sensitivity is to be expected.Nevertheless, the patient achieves a good quality of life with the distal humerus fracture and does not have to expect paralysis or similar restrictions. Malpositions or necessary adjustments of the usual movement sequences often occur. These are necessary to avoid or reduce muscle, tendon or nerve damage. Through targeted training and exercises, the patient can learn to load his body differently. In this way, he improves his general well-being and alleviates existing complaints. This process takes several months until subsequently the patient is almost free of complaints.
Prevention
As is true with most fractures, prevention of distal humerus fracture can at best be accomplished by increased awareness of potentially hazardous activities. In particular, appropriate joint protectors should be worn during sports where falls are more likely to occur. However, if sufficient force is applied, even these cannot guarantee protection from a distal humerus fracture.
Aftercare
In most cases, very few aftercare measures or options are available to the patient for this condition, so early detection must be performed first and foremost in this process to prevent further complications or limitations in movement. The earlier the humerus fracture is diagnosed and treated, the better the further course of this disease usually is. Self-healing cannot occur in this case, so a visit to a doctor is necessary. In most cases, treatment of the humerus fracture is carried out with the help of surgical interventions, which should permanently alleviate the symptoms. Sufferers are advised to rest and take it easy for a while after such a procedure. To refrain from exertion or other stressful activities. In particular, the affected region of the body should not be subjected to unnecessary stress. Furthermore, physiotherapy measures are usually very useful. As a rule, the affected person can perform many exercises from such a therapy at home and thus possibly accelerate the healing process. In most cases, the humerus fracture does not reduce the life expectancy of the affected person.
Here’s what you can do yourself
If a distal humerus fracture is present, the affected arm is immobilized for several weeks. This is usually done with plaster. This severely restricts everyday life, as movements are only possible with the other arm. The prescribed rest is very important because otherwise the arm cannot heal undisturbed. For this reason, the position of the arm should always remain on the upper body – even at night. This is not always easy – yet there is no alternative. Once the fracture has healed and the cast is removed, it is crucial to reactivate the arm with the help of physiotherapeutic measures. This must be done gradually. Overstraining in everyday life should be avoided at all costs. In most cases, it takes several months before the arm can be fully loaded again. In the first period, only light objects may be lifted and light work performed. Anyone who has previously exercised should wait as long as the doctor recommends. This may well be four to six months. It is not uncommon for about a year to pass before the arm is fully functional again. If the weather changes, the former fracture may continue to be noticeable for several years.
