eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Distal Humerus Fractures: Follow-up

Author: Edward Yian, MD, Consulting Staff, Department of Orthopedic Surgery, Southern California Permanente Group Orange County
Coauthor(s): Madhav Karunakar, MD, Consulting Surgeon, Section of Orthopedic Surgery, Department of Surgery, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Jul 26, 2007

Outcome and Prognosis

Loss of terminal extension is frequently observed after distal humerus fracture. Chronic exertional pain can be observed in up to 25% of patients who have suffered such injury.

Henley and other authors have reported good to excellent results in 92% of treated patients at 1.5-year follow-up.28 Other studies have reported similar numbers, with a range of 60-90% and good to excellent results. Wang and colleagues reported that most poor results tend to occur with complex group C3 fractures and are related to associated injuries and complications.29 In their study of 20 patients, 4 complications occurred: 1 nonunion, 1 malunion, 1 deep infection, and 1 brachial artery laceration.

McKee and colleagues studied functional outcome following surgical treatment for displaced intra-articular distal humerus fractures.30 After 37 months of follow-up, they found a mean flexion contracture of 25° and an arc of motion of 108°. Significant decreases in mean muscle strength were found in both elbow flexion and extension (75% of normal).

Outcome studies have reported healing rates of 80-100% postoperatively. Jupiter reported postoperative arc of motion improved to 100°, with 83% good or excellent functional results.19,20

Regarding surgical exposure for distal humerus fractures, a nonunion rate of up to 40% has been reported from chevron osteotomy outcomes, although some authors contend that poor technique is often the source of the complications. Contributory factors include lack of interdigitation of the osteotomy site, malposition of the intramedullary fixation screw, infection, and broken implants.

Future and Controversies

Distal humerus fractures remain a challenging reconstructive problem for orthopedic surgeons. However, future technology may hold many solutions. With the advent of newer, stronger biocompatible materials, diverse hardware options allow improved reduction and fixation of distal humerus fractures. Lower profile plates and smaller screws allow the surgeon to maintain the original articular congruity needed to prevent posttraumatic arthrosis, which allows for faster and progressive postoperative rehabilitation.

In addition, for the unreconstructable elbow, primary TEA is slowly gaining acceptance. Significant improvements in its design and surgical technique have produced reliable pain relief and functional restoration. While rigid patient selection criteria should be adhered to with this surgical option, TEA may help elderly patients with severe bone loss and comminution.

 


More on Distal Humerus Fractures

Overview: Distal Humerus Fractures
Workup: Distal Humerus Fractures
Treatment: Distal Humerus Fractures
Follow-up: Distal Humerus Fractures
Multimedia: Distal Humerus Fractures
References
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Further Reading

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Keywords

elbow fractures, supracondylar humerus fractures, elbow injuries, distal humerus injuries, elbow joint fractures, single condylar fractures, epicondylar fractures, coronal shear fractures of the articular surface, distal humeral fractures, distal humeral injuries

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Contributor Information and Disclosures

Author

Edward Yian, MD, Consulting Staff, Department of Orthopedic Surgery, Southern California Permanente Group Orange County
Edward Yian, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Madhav Karunakar, MD, Consulting Surgeon, Section of Orthopedic Surgery, Department of Surgery, University of Michigan Medical Center
Madhav Karunakar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and AO Foundation
Disclosure: Nothing to disclose.

Medical Editor

Peter M Murray, MD, Associate Professor of Orthopedic Surgery, Mayo Clinic College of Medicine; Director of Education, Mayo Foundation for Medical Education and Research; Consultant, Department of Orthopedic Surgery, Mayo Clinic, Jacksonville; Consulting Staff, Nemours Children's Clinic and Wolfson's Children's Hospital
Peter M Murray, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Society for Surgery of the Hand, American Society of Reconstructive Microsurgery, Florida Medical Association, Orthopaedic Research Society, and Society of Military Orthopedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor of Surgery, Director, Division of Orthopedic Surgery, Surgeon in Chief, UAB Upper Extremity Fellowship, UAB Highlands Hospital, University of Alabama at Birmingham School of Medicine
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, and Mid-America Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center, Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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