Your distal humerus is the lower end of your upper arm bone (humerus) where it joins the elbow. A fractured distal humerus is a very painful injury that can make it difficult to move your elbow. This type of fracture – which has a risk of long-term complications – is relatively rare, accounting for only around 2% of all adult bone fractures. Sometimes, distal humerus fractures occur alongside other elbow injuries.
Causes of distal humerus fractures
Your elbow is formed of three bones – the distal humerus, radial head which is the end of the forearm bone on the thumb side (radius) and the olecranon which is a part of the forearm bone on the little finger side (ulna). A distal humerus fracture is a break anywhere in the lower end of the humerus. This type of injury is normally the result of falling directly onto the elbow or falling onto an outstretched arm causing one of the bones of the forearm to be driven into the distal humerus leading to a break. A distal humerus fracture can also occur if you receive a hard blow to the elbow, for example, during certain types of sport or in a vehicle collision. If you have osteoporosis which weakens the bones you may be at increased risk of a distal humerus fracture even after a relatively minor fall or bump to your elbow.
There are different types of distal humerus fractures. A stable fracture is where the different sections of broken bone are still aligned, and stay like that when you move the elbow, whereas if the bones are pushed out of alignment this is called a displaced fracture and is unstable. Comminuted fractures – where the bone breaks into many pieces -are particularly common with distal humerus breaks. The fracture commonly extends into the elbow joint surface, which is called an articular fracture.
Symptoms of distal humerus fractures
The main symptom of a distal humerus fracture is severe pain which may make it very sore to move your elbow. The joint may be swollen and bruised and your elbow may feel weak or unstable. If you have an open fracture, a splinter of bone may protrude through your skin and there may be extensive bleeding. This type of fracture will need immediate treatment as there is a high risk of infection.
Diagnosing distal humerus fractures
Your doctor will carry out a physical examination and ask how and when the injury occurred. They will gently feel around your elbow joint to assess for possible fractures or dislocations, as well as checking the sensation in your fingers and wrist to ensure there is no nerve damage or problems with the blood supply. If they suspect a fracture, you will be sent for an X-ray which will show up any breaks in the bone and, if so, what type of fracture you have sustained.
Treating distal humerus fractures
The treatment you receive will depend on the type and severity of your distal humerus fracture. If you have a stable fracture – in which the pieces of bone are still aligned – your bones may heal without surgery. You will need to wear a splint or sling for initial pain relief and you may be given a follow-up X-ray to check the bones have not shifted. After around two or three weeks physiotherapy exercises can start.
However, if you have a displaced fracture or open fracture, you will normally need to undergo surgery. In the case of an open fracture, surgery will be scheduled within twenty-four hours to lessen the chances of developing an infection. You will be given intravenous antibiotics and the wound and bone surfaces will be thoroughly cleaned prior to surgical repair.
Most distal humerus fractures are treated with open reduction and internal fixation. This involves repositioning the bone fragments so they are in their normal alignment. They are then held in place with plates and screws attached to the outside of the bones. Sometimes bone grafting may be needed if there has been significant bone loss or the bone has become crushed. Because of the proximity of the ulnar nerve, it may sometimes need to be gently moved during surgery to prevent it becoming injured. It will be restored to its normal position at the end of the procedure.
If your humerus is so severely damaged it cannot be repaired, you may be offered an elbow replacement which entails removing the elbow joint and replacing it with a prosthetic implant. This is normally only recommended for older patients as an elbow replacement will restrict the weight you are able to lift with your artificial joint. In younger or more active patients, a procedure called arthrodesis may be recommended instead. This involves using plates and screws to make the humerus and olecranon grow together. As a result, the patient will no longer be able to bend their elbow, however the joint will remain strong and they will still be able to rotate their hand. Thankfully it is extremely rare to need to do this operation and most fracture in younger patients are able to be repaired.
Depending on the type of fracture, its severity and your age and lifestyle, your orthopaedic surgeon will recommend which treatment is likely to be best for you.
Rehabilitation from distal humerus fractures
It can take some time to recover from a distal humerus fracture. Even if your bones heal without surgery, you are likely to need a period in a cast or splint and so will need extensive physiotherapy to decrease stiffness and improve the range of motion in your elbow. After a surgical repair of a distal humerus fracture, you will also need to wear a cast or splint for a short while and perform regular exercises as directed by a physiotherapist. You may not be able to use your arm for pushing, pulling or lifting for up to 12 weeks.
A distal humerus fracture can lead to a range of complications and many patients will not regain full use of their elbow in spite of the treatment they receive. Post-traumatic arthritis is relatively common after this type of injury, unfortunately, and sometimes further surgery is needed. Occassionally, bone may start to grow in the soft tissues. This is called heterotopic ossification and it can prevent you from moving your elbow properly. Sometimes it requires surgical removal.
Even without major complications it can take around six months to regain strength and good motion in your arm following a distal humerus fracture.
Related Reading:
A proximal humerus fracture is a type of broken shoulder…
Common Shoulder Injuries Linked to Summer Sports
Unfortunately, over the summer months we tend to see an increase in shoulder injuries…
Spotlight on 3 Common Shoulder & Elbow Fractures
A fracture is a break (full or partial) in one of the bones. Fractures are often caused by some kind of traumatic high-impact injury, or as the result of stress due to overusing the bone.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
