The humeral nail system can be used with or without the sureshot distal targeting system. Fracture separation of the distal humeral epiphyseal complex m a premature. The third edition of the book has been fully updated and extended to describe the latest techniques and covers the complete content of the ao principles course of today. A similar postoperative rehabilitation program was. A 33yearold male sustains a distal humerus fracture and is treated with open reduction and internal fixation of the distal humerus with. A, an anteriorposterior view shows a fairly subtle lucency through the distal humerus. Front view of a comminuted elbow fracture on the left and a side view of an elbow replacement on right. The greater tuberosity, located lateral to the humeral head and on the superior aspect of the humerus, provides the attachment for three of the rotator cuff muscles. From ring et al for very distal comminuted fractures. Postoperative complications of distal humeral fractures.
Sixty humeral shaftfracture patients with a minimum age of 18 years were randomly assigned into two groups. Fractures of the distal humerus may be divided descriptively into. Trigen humeral nail system offers an effective intramedullary nail for humeral fracture management. A distal humerus fracture is a break or crack that involves the distal region of the humerus, which forms the upper part of the elbow joint and lower portion of the arm it is usually caused by a highenergy impact that results from an athletic sport, motor vehicle accident, or a fall on the elbow. Distal humeral fractures in adults are relatively uncommon injuries that require operative intervention in the majority of cases.
Exposure of a complex intraarticular fracture may best be achieved through a posterior approach with osteotomy of the olecranon process. Pdf distal humerus fractures are a challenge in diagnosis, surgical intervention, and rehabilitation. Type 2 is a type 1 with comminution of lateral condyle. We herein report a case of medial condyle fracture kilfoyle type iii in an 11yearold boy. An integer programming model for distal humerus fracture. The most useful rehabilitation protocol is the threephase system. Ntdy2 y plate for distal humeral fracture right size 2 ntgy3 y plate. Early intervention is the key to a successful recovery. Distal humerus fracture fixation, surgical preplanning, computer assisted orthopaedic surgery introduction distal humeral fractures account for less than 1% of adult fractures. Open intraarticular distal humerus fractures classified as orthopaedic trauma association ota c may have devastating consequences for patients quality of life, especially if leading arm in. Distal humerus fracture is very common in pediatric patients.
Distal humeral fracture an overview sciencedirect topics. A fishtail deformity is one of the wellknown complications following pediatric lateral condyle or supracondylar fractures of the humerus. Although you may recognize this as a fracture, the degree of displacement appears minimal. If a fracture or fracture repair is stable, then therapy should be started early. Intraoperative measurements included blood loss and operative time. Humeral supracondylar fracture an overview sciencedirect. Displaced coronal shear fractures of the distal humeral articular surface require operative. Distal humeral fractures msd manual professional edition. Treatment options for distal humeral fractures fractures of the distal humerus are less common than other fractures frequently encountered by orthopaedic surgeons, yet when encountered, often provide significant challenges in management. Although historically, these injuries have been treated nonoperatively, advances in. Distal humerus fractures orthopaedic trauma association. Distal humerus fractures what i have learned principles of orif restore articular congruity maximize fixation in distal fragments at least three screws medially and laterally screws as long as possible compress supracondylar component of fracture robust plates if shaft extension 21 yo snowboarding special plates not needed for. A pitfall in fixation of distal humeral fractures with pre. Distal humerus orif fracture early motion therapy protocol.
Open treatment of distal humeral fractures with an extensor mechanismon approach results in excellent healing, a mean elbow flexionextension. Fashion removable longarm splint holding the elbow in 90 degrees of. Separation of the distal humeral epiphysis in the neonate. Operative treatment is reserved for the majority of distal humeral fractures including displaced fracture, vascular injury, and open fractures. The mainstay in diagnosing distal humerus fractures is conventional radiography, including views of the wrist and shoulder to rule out concomitant injury. Open treatment of distal humeral fractures with an extensor mechanismon approach results in excellent healing, a mean elbow flexion extension. Fehringer, md investigation performed at the department of orthopaedic surgery and rehabilitation, university of nebraska medical center, omaha, nebraska. Plate positioning plate position on the distal humerus will be dictated by fracture pattern andor patient anatomy and will differ according to the plating configuration that was. Sep 23, 2019 sixty humeral shaftfracture patients with a minimum age of 18 years were randomly assigned into two groups. Distal humerus fractures of the elbow orthoinfo aaos. Outcomes following distal humeral fracture fixation with.
Apply distal humeral plates and provisionally secure them with kirschner wires in either parallel or orthogonal orientation depending on your preference, your philosophy regarding distal humeral fracture fixation, and the fracture pattern. Although historically, these injuries have been treated. We describe 3 patients ages 27, 49, and 73 years with a bicolumnar fracture of the distal humerus where very. Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Good quality radiographs should be obtained although this may be difficult due to patient discomfort. Erpelding, md, adam mailander, otrl, robin high, mba, ma, matthew a. Throwers fracture of the humerus mdedge emergency medicine. Comminuted intraarticular fracture in the elderly promotes immediate rom usually limited by poor remaining bone stock bag of bones technique rarely indicated if at all distal impacted fractures in elderly with early rom cast or cast brace indicated for completely non displaced, stable fractures.
Distal humeral fractures musculoskeletal medicine for. A similar postoperative rehabilitation program was applied for all subjects for the next 12 months. For the distal humerus, the ap is taken with the elbow flexed to 40 degrees to facilitate olecranon disengagement from the. Distal humeral fractures represent 2% of all adult elbow fractures. Pdf fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation orif. All implants of the t2 humeral nailing system are cannulated and made of type ii anodized titanium alloy ti6al4v for. A 6yearold boy fell from a chair, injuring his left elbow. The implants of the alians elbow range are dedicated to the fixation of fractures and osteotomies of the distal humerus and proximal ulna in adults.
A throwers fracture is a rare fracture pattern characterized by a spontaneous fracture of the mid to distal third of the humeral diaphysis during an attempted throwing motion. The majority of such fractures result from highenergy trauma, and these types. Proximally, secure each plate to bone with a screw through a slotted hole. Frontal view of a distal humerus fracture treated with condylar humeral plating fractures in patients with poor bone quality or extensive comminution may be candidates for elbow replacement. The distal humerus articulates with the radius and ulna at the elbow. Outcomes following distal humeral fracture fixation with an. For diaphyseal fractures of the distal third of the humerus see humeral shaft fractures classification. If the plate is long, the radial nerve needs to be elevated. If using the sureshot distal targeting system, be sure to read and understand the trigen sureshot distal targeting system user manual. Rehabilitation programs for operative and nonoperative.
Rehabilitation guidelines for proximal humerus fracture nonoperative 3 p a g e appointments continue physical therapy 12 xweek rehabilitation goals increase rtc strength restore scapulahumeral rhythm precautions none suggested therapeutic exercises posterior capsule stretching if indicated. Identify the ulnar nerve and elevate it at the ulnar epicondyle if necessary. Humerus, distal ao principles of fracture management. We herein report a distal humeral diaphyseal fracture in a child. Pdf management of distal humerus fractures researchgate. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. In general, the least comminuted column of the humerus should be reduced and fixed prior to the more comminuted one. Proximal humerus fracture book twin cities orthopedics. Fractures of the distal humerus account for 2% of all fractures and onethird of those at the elbow. Aug 16, 2019 the difficulty in treating complex distal humerus fractures lies in the unique and specific anatomy of the distal humerus, which allows it to articulate freely with the radius and ulna. Exposure of a complex intraarticular fracture may best be.
Medial condyle fracture kilfoyle type iii of the distal. Ten months later, he returns complaining of limited range of motion and continued pa. From ring et al for very distal comminuted fractures type 1 capitellum and lateral trochlea type 2 is a type 1 with comminution of lateral condyle type 3 is a type 2 with comminution behind capitellum with impaction type 4 is a type 3 with trochlea posterior involvement type 5 is a type 4 with fracture of medial condyle. Fractures of adult distal humerus arefractures of adult distal humerus are relatively uncommon comprisingrelatively uncommon comprising approximately 2%of all fractures and oneapproximately 2%of all fractures and one third of all humerus fractures. All other abnormalities may affect joint congruency and union rate. Innovation means motion alians elbow distal humerus y plates technical features alians elbow distal humerus y plates references indications.
Intraarticular reduction and stability of the distal humerus are critical to achieve successful outcomes. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint. A fracture in this area can be very painful and make elbow motion difficult or impossible. A retrospective study of a case series was conducted using data collected from medical records of 15 patients with closed fracture of the distal third of the humeral shaft, and treated with the mipo technique treated at the orthopedics ward. Outcomes following distal humeral fracture fixation with an extensor mechanismon approach jason m. This is when the proximal humerus is fractured, and the joint surface of the ball humeral head and socket glenoid are out of their normal alignment. Articular fractures of the distal humerus emconsulte. Normally, the anterior humeral line, which is drawn along the anterior border of the humerus on a lateral xray, transects the middle of the capitellum. If the line transects none or only the anterior part of the capitellum, a distal humeral fracture with posterior displacement may be present. Distal humeral fractures in adults are complex and technically demanding injuries to manage. Distal humeral fracture fixation with an extensor mechanism.
He had a transient fishtail deformity of the trochlear groove after open reduction and internal fixation. Avoid exercises which reproduce the mechanism of injury. Fractureseparation of the distal humeral epiphyseal complex m a premature. Ao principles of fracture management is an essential resource for orthopedic trauma surgeons and residents in these specialties. One common humeral compression screw to close the fracture site, and end caps in six sizes are available to provide an improved fit for every indication to allow nail length adaptation after insertion and to prevent bone ingrowth. For diaphyseal fractures of the distal third of the humerus see humeral shaft fractures. A thorough knowledge of fracture patterns is necessary in order to properly treat and restore ideal elbow biomechanics. Minimally invasive plating osteosynthesis for middistal. Alians elbow distal humerus y plates technical features alians elbow distal humerus y plates references indications. Rehabilitation programs for nonoperative humeral fractures dr.
These are then further subdivided subdivided into groups 1, 2 and 3 on the basis of the location of the line of the fracture and the amount of fragmentation. The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. This 4yearold female fell from a couch onto her outstretched hand, sustaining a supracondylar humeral fracture. Fixation of distal humerus fractures is typically achieved via a dual plate construct.
Dual plate fixation, with placement of a separate strong plate on each column and orientation of the plates either at 90 or 180 to each other, is indicated for all adult fractures involving both columns of the distal part of the humerus. Injury mechanisms include highenergy trauma with skin involvement, and low energy trauma. Distal humerus fracture open reduction and internal fixation. Part of the depuy synthes locking compression plate lcp. Open reduction and internal plate fixation is most often the procedure of choice because it gives the patient the opportunity to begin active and passive rom exercises as soon as tolerated.
Distal humerus fractures constitute 2% of all fractures in the adult population. Temporarily fix the distal block to the shaft using kwires. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Surgical technique this publication is not intended for distribution in the usa. Part of the depuy synthes locking compression plate. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixedangle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. For the distal humerus, the ap is taken with the elbow flexed to 40 degrees to facilitate olecranon disengagement from the fossa allowing for better visualisation of the distal humerus. The periloc distal humerus plating system offers three anatomically designed plates. Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation orif. Distal humeral fractures are rare but complex fractures to manage because of the bony configuration of the elbow joint, adjacent neurovascular structures, and limited access to the articular surface. Postoperative complications of distal humeral fractures 2796 adults followed up for 6 21 0 years jerker sodergard, jerker sandelin and ole bostman of 96 adult patients with a distal intercondylar, intra was assessed at a reexamination after a mean follow articular fracture of the humerus treated operatively up period of 6 21 0 years.
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