The fractures of the distal humerus are typical of childhood but may also occur in adults. They are mostly caused by indirect trauma such as a fall on the outstretched arm in extension or by direct trauma.
The pain is intense and diffuse across the all joint. The intensity of the pain prevents any movements, except for a minimal flexion.
The doctor will prescribe you an x-ray; sometimes the suspicion of neurological or vascular complications will require the implementation of additional tests such as electromyography or arteriography.
The conservative treatment with a plaster is rare because the stiffness of the elbow after immobilization has a very high incidence. And therefore is better an early resumptions of motion after operative fixation.
Fractured distal humerus – Surgery
We use a variety of different techniques: interosseous wire, plaques and external fixators. The main objective of rehabilitation is the early joint mobilization with careful control of the complications that, in some cases, require a further surgical treatment.
The management of post-surgical rehabilitation must take into great consideration the instructions of the surgeon, who generally allows the movement of pronation and supation very late.
Distal humerus fracture – Rehabilitation
The distal humerus fracture is typical of childhood and is classified as a supracondylar fracture; in adults may be either supracondylar or intercondylar with involvement of the articular surface of the elbow. It is caused mostly by indirect trauma produced by a fall on the outstretched arm in extension (infant) or by direct trauma such as the shock trauma on the car window (adult). The prevention of early (vascular, neurological) and late (joint limitations, instability) complications are the basis for the choice of treatment to be followed which is now substantially surgical as it allows a rapid reduction of the fracture.
The rehabilitation can begin after the removal of post-operative brace. The first phase of the protocol is aimed to the recovery of the wrist mobility through passive mobilization of the limb with attention to joint locks and wrist movements of pronation and supination and extensibility recovery through stretching of all muscle arm chain and forearm. At this stage, to control pain may be useful physical therapy, ice and massage therapy primarily relaxant and draining of the shoulder girdle and the entire upper limb.
Gained the full range of motion, you can advance to the second phase of the rehabilitation program with the aim of strengthening the muscle chain through the use of exercises with rubber bands and weights for biceps and triceps, pro-supinator, stabilizing muscles of the shoulder and girdle scapular. Parallel to the recovery of strength will be included coordination and upper limb dexterity exercises with balls, nets and dexterity exercises with the therapist.
The therapeutic program ends on the sports field for the recovery of the global arm function with the launch/gripping objects exercises and pushups on unstable surfaces (tablets, Bobath balls) to more complex and sport specific exercises for safe return sport and fracture healing.