This document discusses distal humerus fractures and elbow dislocations. It begins with anatomy of the elbow joint and then describes the classification, clinical features, imaging, treatment and complications of distal humerus fractures. These fractures have two peak incidence ages and most common types involve one or two columns of the elbow. Treatment depends on factors like displacement and patient age. Elbow dislocations also have associated injuries and mechanisms described. Closed reduction is usually attempted initially but surgery may be needed for unstable or complex cases. Complications of both include stiffness, neurological issues and post-traumatic arthritis.

1. DISTAL HUMERUS
FRACTURE AND
ELBOW
DISLOCATION
DR. AJAY G K
ASSISTANT PROFESSOR
Orthopaedics Dept.

2. OBJECTIVES
 ANATOMY
 CLASSIFICATION
 CLINICAL FEATURES
 RADIOLOGY
 TREATMENT
 COMPLICATIONS

3. ELBOW JOINT

4. DISTAL HUMERUS
 Coronoid Fossa
 Trochlea
 Medial Epicondyle  Lateral Epicondyle
 Capitellum

5. PROXIMAL ULNA
 Greater Sigmoid Notch
 Lesser Sigmoid

 Notch
 Olecranon

 Process
 Coronoid Process

6. PROXIMAL RADIUS
 Head
 Neck
 Radial/Bicepital Tuberosity

7. JOINTS
Humeroulnar joint and Humeroradial
 - Flexion/extension


Radioulnar joint
 - Supination/pronation

8. Muscles Around Elbow-
Simple
Bicep
Triceps
Wrist flexors
Wrist extensors

9. LIGAMENTS

10. NERVES

11. DISTAL HUMERUS FRACTURE
They have a bimodal age distribution peak
incidences occurring between the ages of 12 to
19 years, usually in males,
Those aged 80 years and older, characteristically
in females
The most common fracture pattern was an extra-
articular fracture accounting for just under 40% of
all fractures.
Bicolumn or complete intra-articular fractures
were the second most common, accounting for
37%.

12. MECHANISM OF INJURY
 Low-energy falls
 High-energy trauma

13. CLINICAL EXAMINATION
 Abrasions, bruising, swelling, fracture blisters,
skin tenting, and open wounds

 Neurological exam must be performed

 Vascular injuries, although rare in distal
humerus fractures, should be assessed by
examining the distal pulses, skin turgor, capillary
refill, and color

 Compartment syndrome of the forearm

15. RADIOLOGY
 Standard Anteroposterior and Lateral
radiographs of the elbow

 Computed tomography (CT) with three-
dimensional reconstructions

16. Fat Pad sign

19. Classification
 Descriptive

 Supracondylar fractures
 Transcondylar fractures
 Intercondylar fractures
 Condylar fractures
 Capitellum fractures
 Trochlea fractures- Laugier’s fracture
 Lateral epicondyle fractures
 Medial epicondyle fractures
 Fractures of the supracondylar process

20. CLASSIFICATION
Mehne and Matta
classification of distal
humeral fractures.
High
T
Low
T
Y H
Medial
Lambda
Lateral
Lambda

21. Riseborough and Radin
classification

22. AO CLASSIFICATION

25. Treatment
General principles
 Anatomic articular reduction
 Stable fixation
 Early range of elbow motion

26. Non operative treatment
 Indications
 Nondisplaced fractures
 Fracture with sever comminution in elderly
patient

 Options available
 Cast immobilisation
 Bag and bones technique

27. Operative treatment
 Indications
 Displaced fractures
 Comminuted fractures in young patient

 Methods available
 Interfragmentary screws
 Dual plate fixation
 Total elbow arthroplasty

29. Complications
 Posttraumatic arthritis
 Failure of fixation
 Loss of motion - Extension
 Heterotopic ossification
 Neurologic injury - Ulnar nerve
 Nonunion of osteotomy
 Infection
 Deformity

30. ELBOW DISLOCATION
 Accounts for 11% to 28% of injuries to elbow
 Posterior dislocation common
 Simple dislocations are associated with ligamentous
failure
 Complex dislocations are associated with fractures
 Highest incidence in 10-20 years age
 Recurrent dislocations are rare

31. Mechanism of injury
 Fall on
outstretched
hand or elbow
 Capsuloligame
ntous injury
progresses
from lateral to
medial – Hori
cycle

34. Associated injuries
 Coronoid fractures
 Radial head fratures
 Nerve injury
 Vascular injury

35. TERRIBLE TRIAD

36. Classification
According to direction of displaccement
 Posterior
 Posteriolateral
 Posteriomedial
 Lateral
 Medial
 Anterior

37. Treatment
 Principles
 Restoration of bony stability is the goal
 Restoration of trochlear notch of ulna
 Radiocapitellar contact
 Lateral collateral ligament is more
 important than medial collateral ligament for
the stability

38. Nonoperative
 Closed reduction under sedation
 followed by above elbow splint for 2 weeks
 Elbow rehabilitation after 2weeks
 Methods of closed redution
1.Parvins method
2.Meyn and Quigleys method

39.  Parvins method  Meyn and Quigleys
method

40. Surgical treatment
 Indications
 Non reducable dislocations
 Unstable dislocations which require ligament
reconstruction
 Dislocation associated with fractures

41. Complications
 Stiffness
 Neurological complications
 Vascular complications
 Compartment syndrome
 Persistant instability/ redislocation
 Posttraumatic arthritis
 Heterotropic ossification