Sunday, September 11, 2011

Distal Humerus Fracture

43 year old female fell on the ice sustaining an intraarticular distal humerus fracture. This is a complex break of the end of the humerus thus involving the elbow joint. The elbow joint was in several pieces. The patient is an active, healthy female who is right hand dominant. Radiographs demonstrate a comminuted (multifragment) fracture of the distal humerus.

Standard radiographs are challenging to interpret, so additional xrays are taken with gentle traction applied to the arm. This helps delineate the fracture fragments.

A posterior approach was utilized to access the elbow. Given the severity of the fracture, including the multiple articular (joint) pieces, an olecranon osteotomy was performed to allow for visualization of the joint. The olecranon is the proximal part of the ulna. Posteriorly, it covers and contains the distal humerus, forming part of the hinge of the elbow joint. An olecranon osteotomy is a surgical procedure in which the olecranon (proximal ulna) is broken in a controlled manner and repaired at the end of the operation. With the olecranon osteotomy complete, the multiple pieces of the distal humerus fracture are fixed anatomically and secured with plates and screws.

Once the distal humerus is repaired, the final part of the operation involves fixing the olecranon osteotomy with a plate and screws.

At one year, the patient is pain free with near full range of motion. She lacks the last 5 degrees of extension and flexes to 135 degrees. She has full pronation and supination. She is back to her usual activities.


Distal humerus fractures are complex injuries which are challenging to fix and can result in significant functional limitations. When dealing with these injuries, it is important to properly identify the complexity of the fracture and adhere to good surgical principles and techniques to maximize patient outcomes.

Authored By: Lisa A. Taitsman, M.D.