Orif Of The Distal Humerus Fractures
A distal humerus fracture is a condition that occurs when there is a break in the lower end of the humerus bone that commonly occurs as a result of severe trauma. Fracture of the distal humerus can affect the movement and function of your arm as well as your work and activities of daily living. Distal humerus fractures are quite common and occur in individuals of all ages from children to the elderly.
What does ORIF mean?
Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of distal humerus fractures to restore normal anatomy and improve range of motion and function.
Anatomy
The upper arm bone is called the humerus. The head of the humerus fits into a shallow socket in your scapula (shoulder blade) to form the shoulder joint. The humerus narrows down into a cylindrical shaft and joins at its base with the bones of the lower arm to form the elbow joint.
Causes of Distal Humerus Fractures
Fracture of the distal humerus may be caused by:
- A direct blow or injury
- Fall on an outstretched arm
- High-impact collision, such as a motor vehicle accident
- Contact sports, such as football
- Fall from a height
A distal humerus fracture can also occur as a result of a pathologic condition that weakens your bones, such as:
- Bone infection
- Osteoporosis
- Tumors or bone cysts
- Bone cancer
Signs and Symptoms of Distal Humerus Fractures
Common signs and symptoms of distal humerus fractures may include:
- Severe pain
- Swelling
- Bruising
- Tenderness
- Stiffness
- Inability to move the arm
- Deformity
Diagnosis
Distal humerus fractures are generally considered an emergency condition. Your doctor may examine the skin to check for any cuts and feel the area to determine the presence of broken bones or other injuries. Your doctor may recommend an X-ray examination to determine the extent of the injury.
Preparation for Surgery
Since ORIF is usually performed to treat severe fractures, it often takes place as an emergency procedure. Prior to surgery, you may have:
- A physical exam to inspect blood circulation and nerves affected by the fracture
- X-ray, CT scan, or MRI scan to assess surrounding structures and the broken bone
- Blood tests
- Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up-to-date with your immunizations
- A discussion with an anesthesiologist to determine the type of anesthesia you may undergo
- A discussion with your doctor about the medications and supplements you are taking and the need to stop if need be
Treatment for Distal Humerus Fractures
The management of a distal humerus fracture is comprised of non-surgical or surgical treatment. The choice of treatment depends on the type and severity of the fracture.
Non-surgical Treatment
The nonsurgical approach involves placing your arm in a sling to immobilize the bones and allow healing, medications, and supplements to promote healing and relieve pain, and physical therapy to prevent stiffness and weakness of the shoulder, restore range of motion, and strengthen muscles.
Surgical Treatment
Open reduction and internal fixation is the procedure most commonly used to treat distal humerus fractures. The surgery is performed under sterile conditions in the operating room under general anesthesia.
- After sterilizing the affected area, your surgeon will make an incision around the upper arm muscles.
- Your surgeon will locate the fracture by carefully sliding in between the muscles of the humerus.
- Your surgeon will put the fragments of your humerus back into position (reduction).
- Next, your surgeon will secure the fragments of the humerus to each other (fixation) by using metal plates, screws, wires, or pins.
- After securing the bone in place, your surgeon will close the incisions with sutures or staples and cover it with a sterile dressing.
Postoperative Care
You will have some pain post procedure and pain medication will be prescribed to keep you comfortable. You will need to keep your arm immobile for several weeks by using a sling to allow bone healing. Your doctor will instruct you on dressings and incision care and applying ice to relieve pain and discomfort.
Physical therapy is suggested to prevent shoulder stiffness, strengthen muscles, and restore range of motion. You will also be advised on diet and supplements high in vitamin D and calcium to promote bone healing.
Depending on your health condition and the extent of the injury, you may be able to go home the same day with follow-up appointments for monitoring progress and for removal of the stitches or staples if necessary.
Risks and Complications
Risks and complications of open reduction and internal fixation of distal humerus fractures include:
- Bleeding
- Infection
- Damage to nerves and blood vessels
- Broken screws or plates
- Anesthetic complications
- Failure to heal
- Avascular necrosis
- Blood clots
- Loss of range of motion
ORIF de Fracturas del Húmero Distal
Una fractura del húmero distal ocurre cuando hay una ruptura en el extremo inferior del hueso del húmero, comúnmente por trauma severo. Esta fractura puede afectar el movimiento y función del brazo, así como el trabajo y actividades diarias. Las fracturas del húmero distal son comunes y ocurren en personas de todas las edades, desde niños hasta ancianos.
¿Qué significa ORIF?
Reducción abierta y fijación interna (ORIF) es una técnica quirúrgica empleada para tratar fracturas del húmero distal para restaurar la anatomía normal y mejorar rango de movimiento y función.
Anatomía
El hueso del brazo superior se llama húmero. La cabeza del húmero encaja en una cavidad poco profunda en la escápula (omóplato) para formar la articulación del hombro. El húmero se estrecha en un eje cilíndrico y se une en su base con los huesos del antebrazo para formar la articulación del codo.
Causas de Fracturas del Húmero Distal
- Golpe directo o lesión
- Caída sobre un brazo extendido
- Colisión de alto impacto, como accidente de vehículo
- Deportes de contacto, como fútbol americano
- Caída desde altura
También puede ocurrir por condiciones patológicas que debilitan los huesos:
- Infección ósea
- Osteoporosis
- Tumores o quistes óseos
- Cáncer de hueso
Signos y Síntomas
- Dolor severo
- Hinchazón
- Hematomas
- Sensibilidad
- Rigidez
- Imposibilidad de mover el brazo
- Deformidad
Diagnóstico
Se considera una condición de emergencia. El médico examina la piel, palpa el área y puede recomendar radiografía para determinar extensión de la lesión.
Preparación para Cirugía
- Examen físico para revisar circulación y nervios afectados
- Radiografía, tomografía o MRI
- Análisis de sangre
- Vacuna antitetánica si no está al día
- Discusión con anestesiólogo sobre tipo de anestesia
- Discusión sobre medicamentos y suplementos y la necesidad de suspenderlos
Tratamiento
No quirúrgico
- Cabestrillo para inmovilización
- Medicamentos y suplementos para aliviar dolor y promover curación
- Fisioterapia para prevenir rigidez, restaurar rango de movimiento y fortalecer músculos
Quirúrgico
ORIF es el procedimiento más común:
- Incisión alrededor de músculos del brazo superior
- Localización de la fractura entre los músculos del húmero
- Reposición de fragmentos (reducción)
- Fijación con placas, tornillos, alambres o pines
- Cierre de incisión con suturas o grapas y cobertura con vendaje estéril
Cuidados Postoperatorios
- Manejo del dolor con medicamentos
- Mantener brazo inmóvil varias semanas con cabestrillo
- Cuidado de incisión y aplicación de hielo
- Fisioterapia para prevenir rigidez, fortalecer músculos y restaurar movimiento
- Dieta y suplementos de vitamina D y calcio
- Alta ambulatoria con citas de seguimiento para retirar suturas o grapas
Riesgos y Complicaciones
- Sangrado
- Infección
- Daño a nervios y vasos sanguíneos
- Ruptura de tornillos o placas
- Complicaciones anestésicas
- Fallo en la curación
- Necrosis avascular
- Coágulos de sangre
- Pérdida de rango de movimiento