Distal Humerus Fractures
嚜澳istal Humerus Fractures
Edward J Harvey MD MSc FRCSC
December 2015
Uploaded April 2016
Fractures of the Distal Humerus
Previous authors and current contributors:
Jeffrey J. Stephany, MD and Gregory J. Schmeling, MD; March 2004
Laura S. Phieffer, MD; Revised January 2006
Gregory J. Della Rocca, MD, PhD; Revised October 2010
Anatomy
? Hinged joint with single axis
of rotation (trochlear axis)
每 At bottom of virtual distal
humeral triangle
? Trochlea is center point of AP
with a lateral and medial
column
? Trochlear axis compared to
longitudinal axis is 4-8
degrees in valgus
4-8 Deg.
Functional Anatomy
? The distal humerus angles forwardlike a hockey stick!
? Lateral decubitus positioning during
ORIF facilitates reconstruction
? The trochlear axis is 3-8 degrees
externally rotated
每 (Least important to worry about if cartilage
reconstructed)
每 Reason it is difficult to get a true lateral
radiograph
35-40 Deg.
Evaluation
? Physical exam
每 Soft tissue envelope
每 Vascular status
? Radial and ulnar pulses
每 Neurologic status
? Radial nerve - most
commonly injured
每 14 cm proximal to the
lateral epicondyle
每 20 cm proximal to the
medial epicondyle
? Median nerve - rarely
injured
? Ulnar nerve
Fig. 33-7 Rockwood and Green
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