Distal Humerus Elbow Fracture

What is Distal Humerus Elbow Fracture

Distal humerus elbow fracture is a break (fracture) in the lower (distal) part of the upper arm bone (humerus) near the elbow. Three bones form the elbow joint. These are the humerus, radius, and ulna.

The distal part of the humerus is at the center of the elbow hinge. It sits in the cup-shaped opening of the ulna, and it creates a joint that allows your elbow to move around. Epicondyle fracture is one type of distal humerus fracture.

What are the causes?

This condition is caused by:

• A hard, direct hit (blow), such as a being hit with a hard object.
• Falling onto an outstretched arm.

What increases the risk?

Children are at greater risk for this type of fracture. There is also a greater risk of this condition among people who participate in activities with a high likelihood of injury or falls, such as:

• Gymnastics.
• Football.
• Skateboarding.
• Biking.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain.
• Inability to move the elbow or straighten the arm.
• Swelling.
• Bruising.
• Stiffness.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and physical exam. Your health care provider may also ask you to try to straighten your arm and move your fingers or wrist. Your health care provider may also check the feeling in your fingertips. You may have X-rays to confirm the diagnosis and to find out more about your condition.

How is this treated?

Treatment for this condition includes:

• Wearing a splint or cast and a sling to hold your elbow still while it heals.
• Icing your elbow to relieve pain.
• Taking NSAIDs to reduce pain and swelling.
• Doing exercises (physical therapy) to ease stiffness and restore movement.

If the bones in your elbow are out of position (displaced), you may need surgery. This may include using metal plates, screws, or pins to hold the bones together. After surgery, you will need to wear a cast or splint, and you will eventually have physical therapy.

Follow these instructions at home:

If you have a splint or sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint or sling if your fingers tingle, become numb, or turn cold and blue.
• Do notlet your splint or sling get wet if it is not waterproof.
• Keep the splint or sling clean.

If you have a cast:

• Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Report any concerns to your health care provider.
• You may put lotion on dry skin around the edges of the cast. Do notapply lotion to the skin underneath the cast.
• Do notlet your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast, splint, or sling is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.

Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a cast, splint, or sling on your arm.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

Safety

• Do notuse the injured limb to support your body weight until your health care provider says that you can.

General instructions

• Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.

Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• Be safe and responsible while being active to avoid falls.
• Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
  • Cardiovascular fitness.
  • Endurance.

Contact a health care provider if:

• You have pain that gets worse or does not improve.

Get help right away if:

• You have ongoing (persistent) numbness or weakness in the elbow, hand, or fingers.
• You notice discoloration of your fingers.
• You have severe pain.
• You cannot move your elbow.

Distal Humerus Elbow Fracture Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Assisted forearm rotation, supination

1. Sit with your left / right elbow bent in an “L” shape (at 90 degrees), and rest your forearm on a table.
2. Keeping your upper body and shoulder still, roll your forearm so your palm faces upward. Make sure your whole forearm is moving, not just your hand.
3. When you cannot go farther, use your other hand to help roll your forearm farther upward until you feel a gentle to moderate stretch.
4. Hold this position for __________ seconds.
5. Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Assisted forearm rotation, pronation

1. Sit with your left / right elbow bent in an “L” shape (at 90 degrees), and rest your forearm on a table.
2. Keeping your upper body and shoulder still, roll your forearm so your palm faces down on the tabletop. Make sure your whole forearm is moving, not just your hand.
3. When you cannot go farther, use your other hand to help roll your forearm farther downward until you feel a gentle to moderate stretch.
4. Hold this position for __________ seconds.
5. Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Assisted elbow flexion

1. Hold your left / right arm at your side, and bend your elbow as much as you can using your left / right arm muscles. If your health care provider told you to limit your motion to a certain degree, do notgo past that degree or angle.
2. Bend your left / right elbow farther by gently pushing up on your forearm until you feel a gentle stretch on the outside of your elbow. If your health care provider told you to limit your motion to a certain degree, do notgo past that degree or angle.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Assisted elbow extension, supine

1. Lie on your back on a firm bed. Make sure that you are in a comfortable position that allows you to relax your arm muscles.
2. Place a folded towel under your left / right upper arm, just above your elbow, so your elbow has room to move.
3. Slowly straighten your left / right elbow.
   • Do notlet your left /right arm do any work unless your health care provider says that you can.
   • If told by your health care provider, you can use your other arm to help lower your left / right elbow as needed.
4. Relax and let the weight of your hand and arm straighten your elbow even more.
   • Do notput anything under your forearm and hand to keep them up in the air.
   • Your forearm and hand should not be touching your bed or the towel.
   • You should feel a stretch on the top of your elbow.
5. If told by your healthcare provider, add a small wrist weight or hand weight to increase the stretch.
6. Hold this position for __________ seconds.
7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercise

This exercise will help to reduce any stiffness or swelling in your hand and help to improve your grip strength.

Exercise E: Grip

1. Grasp a tennis ball in your left / right hand.
2. Slowly squeeze the ball tightly. Try to tense only your hand. This should not be painful.
3. Hold this position for __________ seconds.
4. Slowly release your grip.

Repeat __________ times. Complete this exercise __________ times a day.