While you are in the emergency room, your doctor will apply a splint (like a cast) to your elbow and give you a sling to help keep your elbow in position. Immediate treatment may also include:
Whether or not your fracture requires surgery will then be determined. Some distal humerus fractures can be treated without an operation, but this is rare.
Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not out of place (displaced). It may also be recommended for patients who are at higher risk for surgical complications. For example, patients with severe osteoporosis or other medical conditions may not be able to tolerate surgery.
Your doctor will apply a splint or sling to hold the elbow in place during healing. During the healing process, your doctor will take frequent x-rays to make sure the bone has not shifted out of place.
Splints are typically worn for 6 weeks before supervised motion is started. If the fracture shifts out of position during this time, you may need surgery to put the bones back together.
Surgery is usually required for distal humerus fractures in which:
Because of the increased risk of infection, open fractures are scheduled for surgery as soon as possible, usually within hours. Patient are given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury and the surfaces of the broken bone are thoroughly cleaned out. The bone will typically be repaired during the same surgery. In some cases, however, open fractures will require more than one surgery.
External fixation. For severe open fractures, your doctor may apply an external fixator to hold the bones in place until a second surgery can take place.
In this operation, the doctor makes small incisions into the skin and inserts metal pins through the bones. The pins project out of the skin and are attached to carbon fiber bars outside the skin. The external fixator acts as a frame to help hold the elbow in a good position until a second surgery can be performed. It gives damaged skin time to improve before surgery to fix the fracture and may reduce the risk of infection.
Open reduction and internal fixation. This is the procedure most often used to treat distal humerus fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment and then held in place with plates and screws attached to the outside of the bone.
Total elbow replacement (arthroplasty). In some cases, the humerus is so severely damaged that it cannot be fixed properly and needs to be replaced.
In an elbow replacement, a metal and plastic implant is attached to the humerus after the broken bits of bone are removed. Another metal and plastic implant is attached to the ulna (forearm bone), and the two implants are connected to form a hinge. These implants may be held in place with bone cement.
A patient with an elbow replacement will be not be allowed to lift more than 5 pounds with the affected arm for the rest of his or her life. Because of this, the procedure is typically reserved for patients who are older and do not have to lift heavy objects.
Arthrodesis (fusion). In a younger, more active patient, a severely damaged humerus may sometimes be treated with arthrodesis rather than total elbow replacement. During arthrodesis, the doctor will apply plates and screws to make the humerus and olecranon grow together or fuse as one bone.
Although the patient will lose the ability to bend his or her elbow after fusion, he or she will maintain the ability to rotate the hand and will regain a strong elbow joint. This may be especially important to younger patients or to laborers who work with their arms and hands.
There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits outweigh the risks.
Infection. There is a risk of infection with any surgery. Your doctor will take specific measures to help prevent infection.
Damage to nerves and blood vessels. There is a minor risk of damage to nerves and blood vessels around the elbow. Temporary numbness in the hand, or weakness in the hand and wrist may occur. This is caused by stretching of the ulnar nerve during surgery and may take weeks or months to go away. In rare cases, the ulnar nerve may be injured during surgery, and further surgery may be required to help the nerve recover.
Nonunion. Sometimes, a fracture does not heal. The fracture may pull apart and the screws, plates, or wires may shift or break. This can occur for a number of reasons, including:
If the fracture fails to heal, further surgery may be needed.
Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.
If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.
Be aware that, although opioids help relieve pain after surgery, opioid dependency and overdose has become a critical public health issue. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids.
Whether your treatment is surgical or nonsurgical, recovery from a distal humerus fracture requires much work.
Because nonsurgical treatment can sometimes require long periods of splinting or casting, your elbow may become very stiff. For this reason, you may need a longer period of physical therapy.
During rehabilitation, your doctor or a physical therapist will provide you with exercises to help:
You will not be allowed to lift, push, or pull anything with your injured arm for a period of time. Your doctor will talk with you about specific restrictions.
Depending on the complexity of the fracture and the stability of the repair, your elbow may be splinted or casted for a period of time after surgery.
Physical therapy. Most patients will begin exercises to improve elbow and forearm motion shortly after surgery, sometimes as early as the next day. It is extremely important to perform the exercises as often as directed. The exercises will only make a difference if they are done regularly.
Restrictions. Depending upon the severity of your fracture, your doctor may allow you to use your arm to feed, bath, and dress yourself. However, you may be restricted from lifting, pushing, or pulling activities (including opening or closing doors) with your injured arm for 6 to 12 weeks.
If you have had an elbow replacement, you will have permanent restrictions on how you can use your arm. For example, you will not be allowed to lift, push, or pull anything that weighs more than 5 pounds with your injured arm for the rest of your life. Before leaving the hospital, it is important to have a clear understanding of the restrictions regarding using your arm.
Your doctor will also let you know when it is safe for you to drive a car.
Even with successful treatment, some patients with distal humerus fractures may experience long-term complications.
The elbow is a delicate joint that does not tolerate injury well. Many patients will not be able to regain full motion in the affected elbow, no matter what type of treatment they receive. In most of these cases, the patient cannot fully extend or straighten his or her arm. Fortunately, the loss of a few degrees of straightening does not usually affect the overall function of the arm. Patients who have significant loss of motion may require intensive physical therapy, special bracing, or further surgery. This is uncommon for distal humerus fractures.
Posttraumatic arthritis is a type of arthritis that develops after an injury. Even when your bones heal normally, the cartilage protecting the bones can be damaged, leading to pain and stiffness over time.
Posttraumatic arthritis is a relatively common complication of distal humerus fractures. It can occur shortly after the fracture occurs or may take years to develop. Some patients with posttraumatic arthritis may need further surgery to relieve their symptoms. However, for many patients, there is little pain and no need for further surgery.
A rare problem that may occur after surgery is the growth of bone in the muscles, tendons, and ligaments around the elbow. This is called heterotopic ossification. When this happens, bone grows where it should not be and can block movement of the elbow. In cases where the amount of extra bone is great enough to interfere with flexibility and function, surgical removal may be required.
Most patients can return to their normal activities within about 6 months, although full healing can take up to 2 years. Recovering strength in your arm often takes longer than might be expected—sometimes up to 6 months or more.
Although x-rays may show that the fracture has healed completely, many patients report that they still have limitations in movement. These patients will usually continue to improve over time.
Here are some questions you may wish to ask your doctor if you experience a distal humerus fracture: