When a patient presents with a distal humerus fracture, there are several steps that an orthopaedic surgeon goes through to determine the most appropriate treatment for the injury. First and foremost is a thorough examination of the patient. The position of the arm, visible angulation, neurovascular status, and the amount of distress the patient is in are all important to document. Next, radiographic imaging is obtained to determine the type of fracture being evaluated. Whether operative treatment is required depends on the amount of displacement and angulation.
The humerus bone is located between the elbow in the shoulder. The head of the humerus is a ball and socket type joint at the shoulder level. At the distal end the humerus, i.e., toward the forearm, is a hinge joint, which is the elbow. There are several types of distal humerus fractures that can occur.
A fracture occurs when a bone that is fixed (or relatively fixed) at one point (the fulcrum) has force applied to it, away from that point. The bone bends/flexes to accommodate the force but when that force exceeds the bone’s ability to bend/flex, it will break. The magnitude, direction, and acuteness of the force are directly related to whether the bone will fracture, and to both the type and the extent of the fracture. Less force may be required to fracture a bone if it is applied over a long period of time. Much more force is required to fracture a bone rapidly, and there is a poorer prognosis, and more soft tissue damage, associated with a higher velocity injury.
Spiral fractures occur when there is a twisting or rotational force applied to the bone. In such cases, a fracture begins along the surface of the bone but propagates in a longitudinal circumferential fashion, giving the appearance of a spiral.
Distal humerus fracture medical expert witness specialties include orthopaedic surgery, upper extremity orthopaedic surgery, biomechanics, anthropometry, child abuse pediatrics, emergency medicine, pediatric emergency medicine, and pediatrics.