Elbow - Fracture

ELBOW

Fractures of the distal humerus result from motor vehicle crashes, falls on the elbow (in the extended or flexed position), or a direct blow. These fractures may result in injury to the median, radial, or ulnar nerves.

The patient is evaluated for paresthesia and signs of compro-mised circulation in the forearm and hand. The most serious complication of a supracondylar fracture of the humerus is Volk-mann’s ischemic contracture (a compartment syndrome), which results from antecubital swelling or damage to the brachial artery (Chart 69-4). The nurse needs to monitor the patient regularly for compromised neurovascular status and signs of compartment syndrome.

Other potential complications are damage to the joint articu-lar surfaces and hemarthrosis (blood in the joint). If hemarthro-sis is present, the physician may aspirate the joint to remove the blood, thereby relieving the pressure and pain.

Management

The goal of therapy is prompt reduction and stabilization of the distal humerus fracture, followed by controlled active motion after swelling has subsided and healing has begun. If the fracture is not displaced, the arm is immobilized in a cast or posterior splint with the elbow at 45 to 90 degrees of flexion and in a sling for 4 to 6 weeks. Then a thermoplastic splint is used to support the fracture and rehabilitation exercises are begun.

Usually, a displaced fracture is treated with open reduction and internal fixation. Excision of bone fragments may be neces-sary. Additional external support with a splint is then applied. Active finger exercises are encouraged. Gentle ROM exercise of the injured joint is begun about 1 week after internal fixation. Motion promotes healing of injured joints by producing move-ment of synovial fluid into the articular cartilage. Active exercise of the elbow is performed as prescribed to prevent residual limi-tation of motion.