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Distal Humerus Fracture Fixation
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Distal Humerus Fracture Fixation?
The distal humerus is the lower end of the humerus bone, located in the upper arm, which forms part of the elbow joint. A fracture in this area is referred to as a distal humerus fracture. Distal humerus fracture fixation is a surgical procedure aimed at repairing this type of fracture.
This surgical intervention is aimed at restoring the elbow’s functionality and range of motion, particularly in complex fractures that cannot be treated effectively with non-surgical methods.
When is Distal Humerus Fracture Fixation Needed?
Distal humerus fracture fixation is often considered in the following scenarios:
- Displaced Fractures
When the bone fragments are misaligned or have shifted significantly. - Open Fractures
Where the broken bone has pierced the skin, increasing the risk of infection and requiring immediate surgical attention. - Fractures with Multiple Fragments
Complex fractures involving several pieces of broken bone often require surgical fixation to ensure proper alignment and healing. - Fractures Involving the Joint
Injuries that extend into the elbow joint may necessitate surgical repair to preserve joint function and minimise the risk of arthritis. - Nonunion or Malunion
Cases where a fracture has not healed correctly (nonunion) or has healed in an improper position (malunion). - Severe Osteoporosis
In patients with weakened bones due to osteoporosis, surgical fixation might be necessary to stabilise the fracture effectively.
Benefits and Risks of Distal Humerus Fracture Fixation
Benefits
- Improved Alignment and Stability: Surgical fixation realigns the bone fragments, ensuring they are in the correct position for healing.
- Enhanced Healing: Proper alignment and stabilisation of the fracture can facilitate a more effective and quicker healing process.
- Restored Function: The procedure aims to restore the elbow’s full range of motion and strength.
- Reduced Pain: By stabilising the fracture, pain associated with movement and instability can be significantly reduced.
- Prevention of Complications: Surgical intervention may help in preventing long-term complications such as nonunion, malunion, and post-traumatic arthritis.
Risks
- Infection: A common risk associated with any surgery, particularly in open fractures.
- Nerve or Blood Vessel Damage: The surgery involves working near important nerves and blood vessels, which can be inadvertently damaged.
- Implant Problems: Issues such as loosening or breaking of the hardware used for fixation.
- Stiffness and Limited Mobility: Post-operative scarring and swelling may lead to reduced mobility in the elbow joint.
- Nonunion or Malunion: Despite surgical intervention, there is a risk that the bone may not heal properly.
- Postoperative Pain: While the surgery aims to reduce pain, some patients may experience ongoing discomfort.
Preparing for Distal Humerus Fracture Fixation
Preparation for distal humerus fracture fixation involves several steps to ensure the safety and effectiveness of the procedure:
- Medical Evaluation: A thorough medical assessment, including a review of the patient’s medical history, current medications, and any allergies. This evaluation may include blood tests, an ECG, and other diagnostics to assess overall health.
- Imaging Studies: X-rays, CT scans, or MRI may be required to provide detailed images of the fracture and surrounding structures, aiding in surgical planning.
- Discussion with the Orthopaedic Surgeon: It is crucial for patients to discuss the procedure, expected outcomes, and potential risks with the orthopaedic surgeon. Questions regarding the surgery, recovery time, and post-operative care should be addressed.
- Medication Review: Patients should inform their orthopaedic surgeon about all medications and supplements they are taking. Some medications may need to be stopped or adjusted before surgery, especially those that can affect blood clotting.
- Fasting Before Surgery: Patients are usually required to fast (not eat or drink) for several hours before the surgery to reduce the risk of complications related to anaesthesia.
- Preoperative Physical Therapy: In some cases, preoperative physical therapy may be recommended to enhance the strength and flexibility of the arm, which can aid in post-operative recovery.
What Can You Expect During a Distal Humerus Fracture Fixation?
The distal humerus fracture fixation procedure typically follows these steps:
- Anaesthesia
The surgery is usually performed under general anaesthesia, meaning the patient will be asleep and pain-free during the procedure. - Incision
The orthopaedic surgeon makes an incision over the elbow to access the fracture site. - Fracture Reduction
The broken bone fragments are repositioned into their normal alignment. - Fixation
Metal plates, screws, pins, or wires are used to hold the bone fragments together securely. The choice of hardware depends on the fracture’s nature and complexity. - Closure
Once the bone is fixed, the incision is closed with sutures or staples. - Immobilisation
The arm may be placed in a splint or cast to keep the elbow immobilised during the initial phase of healing.
Post-operative Care and Rehabilitation
Effective post-operative care and rehabilitation are crucial for a successful recovery after distal humerus fracture fixation. The key aspects of post-operative care include:
Pain Management
Pain is a common experience after surgery. The orthopaedic surgeon will provide pain relief medications and instructions on how to manage discomfort at home.
Wound Care
Instructions on how to care for the surgical incision, including cleaning and dressing changes, will be provided. It’s important to monitor the wound for signs of infection.
Physical Therapy
Rehabilitation usually begins soon after surgery. A physical therapist will guide the patient through exercises to improve strength, flexibility, and range of motion in the elbow.
Follow-up Appointments
Regular check-ups with the orthopaedic surgeon are necessary to monitor the healing process. These appointments may include X-rays to assess the position of the hardware and the healing of the bone.
Activity Restrictions
The orthopaedic surgeon will advise on any limitations in activities and when it’s safe to return to normal daily tasks, work, or sports.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
How Long Does It Take to Recover from Distal Humerus Fracture Fixation?
The recovery time can vary, but it generally takes several months to regain full strength and range of motion in the elbow. The exact duration depends on the severity of the fracture, the patient’s overall health, and adherence to the rehabilitation program.
Are There Any Long-Term Effects After Distal Humerus Fracture Fixation?
Most patients recover well and regain full function of the elbow. However, some may experience stiffness, reduced range of motion, or discomfort, particularly in complex fractures.
Is Distal Humerus Fracture Fixation a Permanent Solution?
In most cases, the fixation stabilises the fracture permanently. However, in some instances, further surgery may be required, such as hardware removal if it causes discomfort.
Can I Drive After Distal Humerus Fracture Fixation Surgery?
Driving is typically not recommended until you have regained sufficient strength and control in your arm. Your orthopaedic surgeon will advise when it is safe to resume driving.