Fracture of Distal Humerus

Fracture of Distal
Humerus
Presenter: Dr Ramin Maharjan
Moderator: Dr Prabhav M Pokhrel
Date: 2021-07-20
Contents
• Introduction
• Relevant Anatomy
• Epidemiology
• Classification of distal humeral fracture
• Assessment
• Treatment
• References
DEFINIT
ON
A distal humerus fracture is defined as a fracture with an epicenter that is located within a square whose base is the distance
between the epicondyles on an anteroposterior radiograph.
Distal humerus Fracture
• Fractures of adult distal humerus are relatively uncommon
comprising approximately 2% of all fractures and one- third of all
humerus fractures.
Relevant Anatomy of Distal Humerus
-->The lower end of the humerus forms the condyles which is expended from
side to side,
and has articular and nonarticular parts.
-->The articular parts are:-
Capitellum articulate with head of radius,
Trochlea articulate with trochlear notch of ulna.
-->The non-articular parts are:-
Medial and lateral supra condylar ridge,
Medial and lateral epicondyles,
Coronoid fossa,
Radial fossa,
Olecranon fossa.
The posterior aspect of the lateral column
is relatively flat and wide, well suited for
application of a posterolateral plate.
The capitellum is thought to be particularly susceptible
to shear forces because its centre of rotation is more
anterior in reference to the humeral shaft.
Axial view
1. ULNAR
– Medial head of triceps
– Behind the medial condyle
– Travels between the 2 heads of FCU
2. RADIAL
– 20 cm – 74 % length – Enter
– 14 cm – 51 % length - Exits
– 10 cm – 36 % length – Lateral Inter muscular
septum
3. MEDIAN
– With brachial artery between biceps and
brachialis
– Anteromedial aspect of the arm
– Under the bicipital aponeurosis
• Lateral arcade,
• Medial arcade and
• Posterior arcade
Epidemiology • approximately 2% of all fractures
• bimodal age distribution
The age- and gender-related incidence of distal humerus fractures

Assessment of distal humerus fracture
• Mechanism of injury
• High energy trauma – RTA,
• Low energy fall- fall directly on to the elbow
• Thorough physical examination
• Particularly with high energy trauma
• To identify systemic injuries, associated fractures and compartment
syndrome of the forearm
• Circumferentially examined for abrasions, bruising, swelling, fracture
blisters, skin tenting, and open wounds.
• Neurological exam must be performed and accurately documented
• Gofton et al. Reported that associated incomplete ulnar neuropathy
• Vascular injuries- rare in distal humerus fractures,
• Should be assessed by examining the
• Distal pulses,
• Capillary refill
• Color
• Brachial-brachial doppler pressure index
• Standard anteroposterior and lateral radiographs of the elbow are
usually sufficient for diagnosis, classification, and surgical templating.
• Computed tomography with three-dimensional reconstructions

• Para-tricipital approach
• Highly comminuted fractures
• Considering hemiarthroplasty
Transcolumn Fracture (AO/OTA type A2)
Classification of Distal Humerus Fractures
• Anatomic location of the fracture and its appearance
• AO/OTA classification
• Milch system
• Mehne and Matta classification
• The Ring et al.200 classification
Anatomic classification
• Supracondylar,
• Intracondylar,
• Epicondylar,
• Y-type, and
• T-type.
AO CLASSIFICATION
Mehne and Matta
classification
MILCH CLASSIFICATION
• Milch type I: lateral trochlear ridge intact
• Milch type II: fracture through the lateral trochlear ridge.
Milch
classification
Milch
classification
Jupiter, Mehne and Matta
classification
According to pattern of fracture line in the distal
humerus.
1. High T.
2. Low T
3. Y-type
4. H-type.
5. Medial lambda.
6. Lateral lambda
The Mehne and Matta classification describes the

most often encountered fracture patterns
intraoperatively.
The Ring et al.200 classification
Riseborough and Radin Classification
• Type I: Nondisplaced.
• Type II: slight displacement with no rotation between the condylar
fragment in the frontal plane
• Type III: Displacement with rotation.
• Type IV: Severe comminution of the articular surface.
TREATMENT
OPTIONS
1. Non operative
2. Open reduction internal fixation
3. Total elbow arthroplasty
4. Hemi arthroplasty
1. NON
OPERATIVE
• Rarely recommended in young
• Medically unfit patients
• Weekly radiographs for 3-4 weeks.
• Above elbow casting

• Olecranon traction – Historical
• Collar and cuff method – "Bag of bones”
Olecranon trans screw traction
Collar and cuff
method
• Closed reduction
• Followed by elbow in 90-120 degrees of flexion.
• Elbow is hung freely
• To allow gravity assisted reduction.
• ROM exercises at 2 weeks.

2. OPEN REDUCTION +
FIXATION
• Gold standard
– Enhances the stability
– Immediate ROM
• Relative contraindications/ cant be attained.

– Osteopenia
– Comminution
– Articular fragmentation
– Pre existing diseases .eg : RA
TIMING OF
SURGERY
• 48 – 72 hours.
• If in case its being delayed for weeks

– Well padded splints
– Static external fixator
• With in 2- 3 weeks.
– Increased surgical time
– Difficult reduction
– Increased bleeding
– Increased HO
APPROAC
1. POSTERIOR HES
2. ANTERIOR
3. LATERAL
4. MEDIAL
• Sufficient exposure to allow anatomic reduction.
• Application of required internal fixation
• Minimal soft tissue or bony disruption
• Early mobilization
•Type C 1 fracture
•Olecranon osteotomy
•Parallel plating
• Medial and lateral screws
in the articular surface.
TOTAL ELBOW
ARTHROPLASTY
• Indications –
– When ORIF is not attainable in elderly due to
osteopenia, comminution, articular fragmentation
or pre existing conditions.
• Contraindications
– Active infection
– Insufficient soft tissue coverage
– Younger active patient
Hemiarthroplasty for Distal Humerus Fractures
• Hemiarthroplasty is another surgical option for unreconstructible

distal humerus fractures.
COMPLICATI
ONS
• Non union
• Elbow stiffness
• Heterotopic ossification.
• Wound complications
• Infections
• Ulnar neuropathy.
• Olecranon osteotomy
• TEA - Complications.
REFEREN
CES
1. Rockwood and Green’s- Fractures in adults – 9th Edition
2. Campbell’s Operative orthopaedics – 14th edition.
3. AO Principles of Fractures- 2000.

• Thank you

Fracture of Distal Humerus

Uploaded by

Copyright:

Available Formats

Fracture of Distal Humerus

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Fracture of Distal Humerus

Uploaded by

Copyright:

Available Formats

Fracture of Distal

• bimodal age distribution

The age- and gender-related incidence of distal humerus fractures

• Computed tomography with three-dimensional reconstructions

The Mehne and Matta classification describes the

• Above elbow casting

• Followed by elbow in 90-120 degrees of flexion.

• Elbow is hung freely

• To allow gravity assisted reduction.

• ROM exercises at 2 weeks.

• Relative contraindications/ cant be attained.

• If in case its being delayed for weeks

• Sufficient exposure to allow anatomic reduction.

• Application of required internal fixation

• Minimal soft tissue or bony disruption

• Hemiarthroplasty is another surgical option for unreconstructible

2. Campbell’s Operative orthopaedics – 14th edition.

3. AO Principles of Fractures- 2000.

You might also like