Fractures of the distal end of the humerus

AO classification
A – extraarticular (avulsive a supracondylar)

B – partially intra-articular

C – completely intra-articular

A. Supracondylar (extraarticular)

 * Occur mainly in children in falls when forces act indirectly or directly on the elbow in the sense of hyperflexion or hyperextension.


 * Division
 * Extension:
 * More common, distal fragment dislocated dorsally, anterior fragment may injure the a. brachialis;
 * high risk of forearm compartment syndrome and development of Volkmann's ischemic contracture..
 * Flexion:
 * distal fragment dislocated ventrally.


 * Treatment:
 * Conservative (with intact innervation and blood supply):
 * repositioning by traction and flexion for the extensor type, traction and extension for the flexor type;
 * application of a circular plaster cast (in supination and flexion for the extension type, in extension for the flexion type) - must not press in the elbow socket, checking blood supply and innervation in the periphery - for 4 weeks.


 * Surgery:
 * fixation with two crossed Kirschner wires inserted percutaneously.

B. Intercondylar (intra-articular)

 * more common in adults;
 * arise from a fall on a flected elbow;
 * the fracture line is T- or Y-shaped;
 * dislocated fractures are treated surgically (open repositioning and OSY with screws and splints);
 * only non-dislocated fractures are treated conservatively.

Clinical signs and diagnosis

 * Significant swelling and haematoma of the ulnar landscape, pain on elbow movement; clinically, the epicondyle and olecranon do not form a straight line (in elbow extension) or an isosceles triangle (in elbow flexion).
 * It is necessary to check peripheral blood supply to thea. radialis (possible injury to the a. brachialis) and innervation of the n. radialis.
 * X-ray (mainly lateral projection).

Complications

 * Volkmann's ischemic contracture;
 * limitation of elbow mobility - mainly due to paraarticular ossifications;
 * angular deformities - cubitus varus et valgus.

Related articles

 * Humerus