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ORIF of the Distal Humerus Fractures

What are Distal Humerus Fractures?

A distal humerus fracture is a condition that occurs when there is a break in the lower end of the humerus bone that commonly occurs as a result of severe trauma. Fracture of the distal humerus can affect the movement and function of your arm as well as your work and activities of daily living. Distal humerus fractures are quite common and occur in individuals of all ages from children to the elderly.

What does ORIF mean?

Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of distal humerus fractures to restore normal anatomy and improve range of motion and function.

Anatomy

The upper arm bone is called the humerus. The head of the humerus fits into a shallow socket in your scapula (shoulder blade) to form the shoulder joint. The humerus narrows down into a cylindrical shaft and joins at its base with the bones of the lower arm to form the elbow joint.

Causes of Distal Humerus Fractures

Fracture of the distal humerus may be caused by:

  • A direct blow or injury
  • Fall on an outstretched arm
  • High-impact collision, such as a motor vehicle accident
  • Contact sports, such as football
  • Fall from a height

A distal humerus fracture can also occur as a result of a pathologic condition that weakens your bones, such as:

  • Bone infection
  • Osteoporosis
  • Tumors or bone cysts
  • Bone cancer

Signs and Symptoms of Distal Humerus Fractures

Common signs and symptoms of distal humerus fractures may include:

  • Severe pain
  • Swelling
  • Bruising
  • Tenderness
  • Stiffness
  • Inability to move the arm
  • Deformity

Diagnosis

Distal humerus fractures are generally considered an emergency condition. Your doctor may examine the skin to check for any cuts and feel the area to determine the presence of broken bones or other injuries. Your doctor may recommend an X-ray examination to determine the extent of the injury.

Preparation for Surgery

Since ORIF is usually performed to treat severe fractures, it often takes place as an emergency procedure. Prior to surgery, you may have:

  • A physical exam to inspect blood circulation and nerves affected by the fracture
  • X-ray, CT scan, or MRI scan to assess surrounding structures and the broken bone
  • Blood tests
  • Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up-to-date with your immunizations
  • A discussion with an anesthesiologist to determine the type of anesthesia you may undergo
  • A discussion with your doctor about the medications and supplements you are taking and the need to stop if need be

Treatment for Distal Humerus Fractures

The management of a distal humerus fracture is comprised of non-surgical or surgical treatment. The choice of treatment depends on the type and severity of the fracture.

Non-surgical Treatment

The nonsurgical approach involves placing your arm in a sling to immobilize the bones and allow healing, medications, and supplements to promote healing and relieve pain, and physical therapy to prevent stiffness and weakness of the shoulder, restore range of motion, and strengthen muscles.

Surgical Treatment

Open reduction and internal fixation is the procedure most commonly used to treat distal humerus fractures. The surgery is performed under sterile conditions in the operating room under general anesthesia.

  • After sterilizing the affected area, your surgeon will make an incision around the upper arm muscles.
  • Your surgeon will locate the fracture by carefully sliding in between the muscles of the humerus.
  • Your surgeon will put the fragments of your humerus back into position (reduction).
  • Next, your surgeon will secure the fragments of the humerus to each other (fixation) by using metal plates, screws, wires, or pins.
  • After securing the bone in place, your surgeon will close the incisions with sutures or staples and cover it with a sterile dressing.

Postoperative Care

You will have some pain post procedure and pain medication will be prescribed to keep you comfortable. You will need to keep your arm immobile for several weeks by using a sling to allow bone healing. Your doctor will instruct you on dressings and incision care and applying ice to relieve pain and discomfort.

Physical therapy is suggested to prevent shoulder stiffness, strengthen muscles, and restore range of motion. You will also be advised on diet and supplements high in vitamin D and calcium to promote bone healing.

Depending on your health condition and the extent of the injury, you may be able to go home the same day with follow-up appointments for monitoring progress and for removal of the stitches or staples if necessary.

Risks and Complications

Risks and complications of open reduction and internal fixation of distal humerus fractures include:

  • Bleeding
  • Infection
  • Damage to nerves and blood vessels
  • Broken screws or plates
  • Anesthetic complications
  • Failure to heal
  • Avascular necrosis
  • Blood clots
  • Loss of range of motion