Related Subjects:
|Shoulder Anterior Dislocations
|Shoulder:Posterior Dislocation
|Elbow Dislocation
|Olecranon Fracture
|Distal Humerus Fracture
|Radial Head and Neck Fractures
|Forearm Fractures
|Shaft of Ulna Fracture
|Wrist Colles Fracture
|Wrist Smith’s Fracture
🦴 Introduction
- Distal humerus fractures involve the lower end of the humerus and can be supracondylar (extra-articular, often in children) or intra-articular (involving condyles/trochlea).
- They require careful assessment to prevent complications, including neurovascular compromise and long-term functional disability.
- Most common in children following a FOOSH (fall on outstretched hand).
🩺 Clinical Features
- Often no gross deformity, especially in non-displaced fractures.
- Swelling and tenderness around the elbow.
- Reduction in active elbow movement, particularly reduced flexion.
- Always assess & document neurovascular status:
- Neurology: median, radial, ulnar nerves ➝ motor & sensory.
- Vascular: brachial, radial, ulnar pulses.
🧪 Investigations
- Fractures can be subtle - maintain a high index of suspicion.
- Request AP + lateral X-ray of elbow.
- Anterior Humeral Line (key exam point):
- Draw a line along the anterior cortex of the distal humerus on lateral X-ray.
- It should pass through the middle third of the capitellum.
- If not ➝ suggests posterior displacement (supracondylar fracture).
- Fat pad sign (“sail sign”) ➝ occult fracture indicator.
⚡ Management
- Provide adequate analgesia & immobilisation.
- Apply a long-arm backslab (above elbow, elbow at 90°).
- Re-check and document neurovascular status post-slab.
- Refer urgently to on-call orthopaedics ➝ some displaced fractures require theatre & K-wire fixation.
- Non-displaced fractures may be managed conservatively with close follow-up.
🚨 Complications
- Brachial artery injury ➝ diminished/absent pulse.
- Volkmann’s Ischaemic Contracture ➝ necrosis of forearm flexors, claw-like deformity if missed.
- Median nerve injury ➝ most common neuropraxia in supracondylar fractures.
- Malunion ➝ cubitus varus (“gunstock deformity”).
📅 Follow-up & Rehab
- Orthopaedic review in fracture clinic.
- Repeat neurovascular checks in first 24h ➝ compartment syndrome risk.
- Physiotherapy after immobilisation ➝ regain elbow ROM.
- Prognosis is usually good with early recognition & proper treatment.
