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Fracture of the distal end of the humerus

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A distal humerus fracture occurs when there is a violation of bone integrity in the distal region (lower end) of the humerus.

The bone may crack slightly or break into many parts (a fragmented fracture). Broken pieces of bone may align in a straight line or may not be in place (dislocated fracture).
perelom-distalnogo-otdela-plechevoy-kosti.jpgin some cases, the bone breaks in such a way that its fragments stick out through the skin - this is called an open fracture. Open fractures are especially serious because once the skin is damaged, there is an increased chance of infection in both the wound and the bone. Immediate treatment is required to prevent infection.

Distal humerus fractures are rare, accounting for about 2% of all fractures in adults. They may be part of a more complex elbow injury.

Reason

Fractures of the distal part of the humerus are most often caused by:
  • falling directly on the elbow< / li>
  • receiving a direct blow to the elbow from something heavy, such as a baseball bat, dashboard, or car door during a vehicle collision
  • falling on an outstretched arm with the elbow tightly pressed to the torso. In this situation, the ulna (one of the forearm bones) enters the distal humerus and this leads to its rupture.

Fractures of the distal part of the humerus are also sometimes caused by a weak force of injury, this is most common in elderly patients whose bones have weakened as a result of osteoporosis.

Sympoms

A distal humerus fracture can be very painful and restricts movement in
elbow joint.
Other symptoms of a fracture may include:
swelling
subcutaneous hematoma
palpation pain
real estate
feeling unstable in the joint, as if your elbow is about to "pop out"
in rare cases, a broken bone may protrude from the skin (open fracture)

Survey

    < li>examination of the skin for cuts and tears: in severe fractures, bone fragments can break through the skin, increasing the risk of infection;< / li>
  • palpation around the elbow to determine if there are other areas of pain. This may indicate other broken bones or injuries, such as a dislocated elbow.
  • you need to make sure that the hand and fingers have good blood circulation by feeling the pulse on the wrist; < / li>
  • you need to make sure that you can move your fingers and wrist and feel your fingers. In some cases, the ulnar nerve may be damaged at the same time as the fracture. This can lead to weakness and numbness of the fourth and fifth fingers.
Diagnostics

The best way to diagnose a fracture is radiography.

In case of questionable radiography results and when planning surgical treatment, computed tomography may be recommended, which can show an accurate picture of the fracture in three-dimensional reconstruction.

Magnetic resonance imaging or ultrasound may be required to diagnose soft tissue damage (ligaments, tendons, nerves, etc.).

Conservative treatment

Conservative treatment may be recommended for stable fractures in which bone fragments are not displaced. This method may also be recommended for patients with an increased risk of surgical complications.

To fix the elbow, you need to apply a polymer splint or a removable bandage. The healing process is monitored by X-rays to make sure that the bone has not moved.

Splints are usually worn for 6 weeks before controlled movement begins.

If the fracture is displaced, surgical treatment may be required.

Surgical treatment

Surgery is usually required for the following fractures of the distal humerus:
    < Li>bones displaced (fracture displaced)< / li>
  • parts of the bone punctured the skin (open fracture)< / li>

External fixation. In the case of serious open fractures, an external retainer is used to stabilize the bones before the second operation.

In this operation, small incisions are made on the skin and metal foams are inserted through the bones. The foam protrudes from the leather and attaches to a carbon fiber frame on the outside of the leather. The external retainer acts as a frame, helping to keep the elbow in a good position until the second operation is performed. This gives the damaged skin time to improve before surgery to correct the fracture and can reduce the risk of infection.

Open reposition and internal fixation. This procedure is most commonly used to treat fractures of the distal humerus. During the procedure, the bone fragments are first moved to their normal position and then held in place by plates and screws attached to the outside of the bone.

Complete replacement of the elbow joint (arthroplasty). In some cases, the humerus is so badly damaged that it cannot be properly repaired and requires replacement.

When replacing the elbow joint, a metal and plastic implant is attached to the humerus after the broken bones are removed. Another metal and plastic implant is attached to the ulna (forearm bone), and the two implants are connected in a hinge.

Whether your treatment is surgical or non-surgical, recovering from a distal humerus fracture requires a lot of work.

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Advantages of treatment in Orthopedics by Ruslan Sergienko

  • 10 years on medical services in Ukraine
  • > 25 years of experience with leading specialists
  • Anna Vovchenko and Ruslan Sergienko are recognized opinion leaders among the orthopedic traumatologists
  • > 150,000 consultations were held
  • > 7,500 surgeries were performed
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