Distal Humerus Fracture

Gartland Classification
Type IA : nondisplaced fracture
Type IB : medial impaction fractures
Type IIA : fractures fragments with posterior angulation
Type IIB : fractures with malrotation
Type IIIA : complete posteromedial displacement
Type IIIB : complete posterolateral displacement
A simpler classification would be:
i) non displaced
ii) 1 cortex intact
iii) totally displaced

Mechanism of Injury
Fall on outstretched hand

Examination
Elbow swollen and tender, with decreased range of motion due to pain
Exclude neurovascular injuries:
Radial nerve, median nerve, ulnar nerve palsy
Brachial artery disruption or contusion
Compartment syndrome

X-rays
AP and lateral views of elbow
Look for posterior fatpad sign in undisplaced fracture in lateral view

Management
Type I fracture : Long-arm backslab with elbow in 90 flexion and forearm in neutral position. Triangular arm sling. Analgesics. TCU Ortho SOC 1/52

Type II fracture : Attempt M&R. Long-arm backslab. Triangular arm sling.
Loss of <20 angle-shaft angulation can be accepted (normal 45 )
TCU Ortho SOC 1/52
If unable to achieve satisfactory reduction, admit to Ortho Dept
Type III fracture: Check neurovascular status
Long arm backslab. Triangular arm sling
Admit to Department of Orthopaedic Surgery
Nerve injury : Admit to Department of Orthopaedic Surgery
Brachial Artery Injury : If unable to fell brachial pulse despite M&R, contact Ortho MO-on-call stat to review patient at A&E. All cases to be admitted to Ortho Dept for circulation monitoring even if pulses return.
Consider x-ray of other elbow for comparison in paediatric cases.