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synonyms: supracondylar humerus fracture, intercondylar humerus fracture, T condylar humerus fracture, transcondylar humerus fracture, Y condylar humerus fracture, distal humerus fracture
Distal Humerus Fracture ICD-10
Distal Humerus Fracture ICD-9
- 812.40 (fracture of humerus, lower end, unspecified, closed)
- 812.41 (fracture of humerus, supracondylar, closed)
- 812.51 (fracture of humerus, supracondylar, open)
- 812.50 (fracture of humerus, lower end, unspecified, open)
Distal Humerus Fracture CPT
Distal Humerus Fracture Etiology / Epidemiology / Natural History
- Generally from a fall onto the posterior elbow, fall onto outstretched hand, or MVA.
- Bimodal distribution: patients in second decade with high-energy trauma and elderly patients with low-energy falls.
Distal Humerus Fracture Anatomy
- Distal humerus is composed of a medial and lateral columns separated by the trochlea.
- Medial column diverges from the humeral shaft at @45º angle.
- Lateral Column diverges from the humeral shaft at @20º angle.
- Trochlea has a 300º arch of cartilage.
- see also Elbow Anatomy.
Distal Humerus Fracture Clinical Evaluation
Distal Humerus Fracture Xray / Diagnositc Tests
- A/P, lateral and oblique views of the elbow demonstrate fracture.
- CT scan: typically indicated do to complexity of most distal humerus fractures. 3D reconstructions with radius and ulna subtracted are beneficial.
Distal Humerus Fracture Classification / Treatment
Distal Humerus Fracture Associated Injuries / Differential Diagnosis
Distal Humerus Fracture Complications
- Superficial wound infection
- contracture
- Nonunion
- Hardware failure
- Malunion
- Painful hardware
- Ulnar nerve palsy
- Radial nerve palsy
- Heterotopic ossification
Distal Humerus Fracture Follow-up Care
- Post-op: Posterior splint, NWB.
- 7-10 Days: Remove splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Active flexion, gravity extension. Active extension avoided for 6wks. Generally start physical therapy for ROM and strengthening
- 6 Weeks: Begin active extension, strengthening exercises provided fracture union is evident on xray.
- 3 Months: Ensure full restoration of shoulder and elbow ROM. Consider bone stimulator if union is delayed. Sport specific rehab.
- 6 Months: return to full activities / sport.
- 1Yr: Follow-up xrays, assess outcomes.
- Outcome after ORIF of intra-articular Fracture’s= Mean flexion contracture-25 degress, mean arc of motion-108 degrees, @75% of normal strength. 24% reoperation usually for HWR (McKee JBJS 2000;82A:1701).
- Elbow Outcome Measures.
Distal Humerus Fracture Review References
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