Arm Bone Fractures (Distal Humerus Fractures): Treatment Options

Arm Bone Fractures (Distal Humerus Fractures): Treatment Options

This video will review the treatment options for arm bone fractures, also called distal humerus fractures. When a patient presents with a possible arm bone fracture near the elbow, initial treatment focuses on addressing any open wounds, providing pain medication as needed for comfort and stabilizing the fracture in a splint.

After a thorough physical examination and review of the imaging studies, the health care professional will classify the fracture based on: where the bone is broken, how many pieces are broken, and whether the broken pieces are aligned or not aligned. Also called nondisplaced and displaced fractures. This classification will be considered along with the patient's age, overall health and medical history, daily activity, and bone quality before recommending nonsurgical or surgical treatment.

If fractures are left untreated, the arm bone may not heal properly or may heal in poor alignment, leading to pain and loss of motion in the elbow joint. Nonsurgical treatment is generally recommended for 2 groups of patients. Small nondisplaced fractures can be immobilized with a cast or a splint for several weeks as healing is monitored with x-rays. Physical therapy is slowly introduced to regain motion and strength.

For displaced fractures in patients who are not surgical candidates, the elbow will be immobilized in a splint or sling for 2-3 weeks to allow the soft tissue structures to heal, followed by early incorporation of motion exercises. While 95% of these patients will regain function of the elbow, most of them will not return to high demand activities. Nonsurgical treatment carries risks, including incomplete healing, elbow stiffness and the possible need for surgery at a later time.

Surgical treatment is recommended for most other arm bone fractures to improve healing and restore elbow motion. The most common approach is called open reduction internal fixation, or O R I F, where the surgeon makes an open incision along the arm to put the fracture pieces back together. One or more plates are selected to fit the arm bone, and the fracture classification, and screws are used to hold everything in place while the bone heals.

A total elbow replacement is less common but may be an appropriate treatment for fractures at the joint surface that are too displaced to be put back together, or for elderly patients with limited daily activity or poor bone quality. In this procedure, the damaged joint surfaces of the arm bone and forearm bones are replaced with metal and plastic implants to allow for regular motion. For both surgical options, the surgeon pays careful attention to the ulnar nerve to not damage it during surgery.

Recovery depends on the treatment selected. After surgery, patients are typically placed in a splint for a short period to allow the soft tissues to heal. Gentle range of motion exercises are introduced early to limit stiffness in the elbow. Medications may be prescribed to manage pain and swelling. Once follow up x-rays show healing, physical therapy progresses to strengthening exercises.

Patients treated with ORIF will be able to return to activity without long term restrictions, while patients treated with a total elbow replacement will have a lifelong lifting restriction of approximately 10 pounds with the affected arm. In summary, arm bone fractures are treated based on the patient's age, health, activity level, and fracture classification. Nonsurgical treatment is available for small fractures and patients who are not surgical candidates. Surgical treatment is often recommended for more complex fractures, with the most common options being open reduction internal fixation or total elbow replacement. Recovery and long term expectations vary based on the treatment selected.