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 or intra-articular.
- They are challenging to diagnose and manage due to their proximity to vital neurovascular structures.
- Careful assessment is essential to prevent complications such as neurovascular injury and long-term functional impairment.
⚡ Causes
- 🤲 Fall on an outstretched hand (FOOSH)
- 💥 Direct trauma to the elbow
- 🏉 High-energy sports injuries
- 🚗 Motor vehicle accidents
⚠️ Risk Factors
- 🦴 Osteoporosis → increased susceptibility to fractures
- 🤼 Participation in contact or high-impact sports
- 👵 Frequent falls in elderly or balance-impaired individuals
- ⚒️ Occupational hazards (construction, manual labour)
🩺 Clinical Features
- Usually not associated with gross deformity
- Restricted range of motion, particularly loss of flexion
- Assess and document neurological function (median, ulnar, radial nerves)
- Assess and document vascular function (brachial, radial, ulnar pulses)
🩻 X-Ray Findings
- Fractures may be subtle - always get orthogonal views.
- Supracondylar fractures are best seen on the lateral view.
- Anterior Humeral Line:
- Draw a line along the anterior border of the distal humerus.
- Normally passes through the middle third of the capitellum.
- If it passes anterior to the capitellum → suggests posterior angulation (supracondylar fracture).
🛠️ Management
- 💊 Ensure adequate analgesia (IV paracetamol ± opioids).
- 🩹 Apply a long-arm backslab with elbow flexed at ~90°.
- ✅ Re-check and document neurovascular status after immobilisation.
- 📞 Refer urgently to orthopaedics for definitive management.
⚠️ Complications to Beware
- 🩸 Brachial artery injury - particularly in displaced supracondylar fractures.
- Ischaemia → risk of Volkmann’s Ischaemic Contracture → necrosis of forearm muscles.
- Careful documentation of:
- 🔹 Brachial pulse
- 🔹 Radial pulse
- 🔹 Ulnar pulse
- Neuropraxia of median, radial, or ulnar nerves may occur.
