Edited by Carew Giberson-Chen and Jeffrey "Spud" Olson - 7/1/2021
Descriptors
AO/OTA classification:
Type A: Extraarticular (supracondylar)
Type B: Partial articular: single (medial/lateral) column involvement
Type C: Complete articular: bicolumnar fracture, intercondylar split most common
Coronal shear (i.e. capitellar shear)
Associated injuries: elbow dislocation, terrible triad (radial head fx, coronoid fx, posterior elbow dislocation), floating elbow
Exam Pearls
Upper extremity neurovascular exam
Carefully inspect skin to rule out open fracture
Avoid ROM due to risk of neurovascular compromise
Assess median, radial, and ulnar nerve function
Assess distal pulses (risk of brachial artery injury)
Workup
Radiographs: AP and lateral elbow XRs with single AP traction view
Other imaging: CT elbow with 3D reconstruction for pre-op surgical planning
Labs: Pre-op labs (CBC, BMP, T&S, CXR, EKG, UA, covid swab)
Other: Surgical consent if operative
Management
Need for acute intervention: Yes, immobilization without reduction
Weight-bearing and range of motion: NWB in splint
Type of immobilization: posterior slab splint
Admission or discharge status: Admit for surgery
Anticoagulation: Lovenox 40mg SC QHS while admitted
Antibiotics: None unless open
Surgical Indications
Absolute:
Open fracture
Vascular compromise
Relative: All distal humerus fractures are operative except for non-displaced single column fractures with lateral trochlear ridge intact (Milch Type I)
Not an indication: Milch Type I (see above) -- cast immobilization