What is a distal humerus fracture fixation?
Distal humerus fracture fixation is a type of surgery done by Dr. Mazzara that will “fix” the bones of the elbow joint in their proper position so they can heal. Surgery is required for all displaced fractures (where the bones do not line up correctly) and open distal humerus fractures (when part of the bone has broken through the skin.) There are several methods of distal humerus fracture fixation which include external fixation and internal fixation. These surgical methods are as follows:
- External distal humerus fracture fixation: Used when severe, open fractures have occurred, Dr. Mazzara may apply an external fixator to hold the bones in place. This is a temporary fixation often used in emergent situations where the patient has other medical requirements and is not stable enough for surgery.
- In this fixation, Dr. Mazzara makes small incisions into the skin and inserts metal pins into the bones. The external pins are attached to a bar outside the skin and the bones are reduced (moved into correct position) and then held in a good position by the bar, until a second surgery can be performed safely.
- Open reduction and internal distal humerus fracture fixation: Used most often to treat distal humerus fractures. During this surgery, Dr. Mazzara repositions (called reducing) the bone fragments into their normal position and then held in place with plates and screws.
Depending on the extent of injury and the type of fracture, Dr. Mazzara may need to perform one or more of the following during the distal humerus fracture fixation:
- Ulnar nerve transposition: Often the nerve needs to be moved temporarily during surgery to prevent injury. Once repairs are completed the nerve is moved back to its correct position
- Bone grafting: If some of the distal humerus has been lost, crushed or damaged, Dr. Mazzara may need to do a bone graft to fill the space lost. Bone grafts can be taken from a donor (allograft) or from another bone in the patient’s own body (autograft.)
- Osteotomy: Sometimes Dr. Mazzara will need to temporarily remove the olecranon (bony tip of the elbow) to see the distal humerus better. Once the humerus has been repaired, the olecranon is replaced and held in its normal position with screws or pins and wire.
- Arthroplasty: Total elbow joint replacement is done only in the most severe cases where the bones are damaged so badly, they cannot be repaired. In an elbow replacement, metal and plastic implants called a prosthesis is attached to the humerus and the ulna. The two are then connected to form a hinge. This type of treatment is always reserved for the older patient with low physical demands.
- Arthrodesis: Fusion of the elbow joint may be necessary for extreme damage in younger patients who are active and need to maintain a strong elbow joint. Fusing the humerus to the olecranon results in the inability to bend the elbow, however patients will be able to rotate the hand.
How long does it take a distal humerus fixation to heal?
Most patients return to normal activities within 6 months, although a full recovery may take up to two years. Patients will need physical therapy once the joint has been found stable by Dr. Mazzara. Strength exercises can help patients restore the power of the joint, although it is not uncommon for patients to find a deficit in the arm after recovery.
For more information about distal humerus fracture fixation, please contact the offices of Dr. James Mazzara, orthopedic elbow surgeon, treating patients in Manchester, South Windsor, Enfield, Glastonbury and surrounding Hartford communities.