Timing of treatment of fractures of the distal humerus
1. General considerations
Depending on the type of fracture, different factors have to be taken into account regarding timing of treatment.
2. Supracondylar fractures
Open supracondylar fractures and fractures with vascular compromise are contemporary indications for emergency surgery.
Treatment delayed by 12-24 hours has no negative effect on the outcome following closed reduction.
The following points influence the timing of the treatment:
- Availability of surgical resources
- The patient should be treated on a routine operating list within 24 hours of injury. Temporary plaster splint immobilization and elevation of the elbow joint are recommended for pain management
3. Intraarticular fractures
Intraarticular fractures of the distal humerus do not require emergency surgery.
Surgical treatment of this fracture can always be conducted during the 2-3 days following injury.
Plaster cast immobilization and elevation of the elbow for pain relief are sufficient in the meantime.
4. Ligament avulsion and elbow dislocation
Isolated ligament avulsions, such as medial epicondyle fractures, never require emergency surgery.
Elbow dislocation should be reduced as soon as possible, no later than 12 hours from injury, unless there are neurovascular complications, which require immediate intervention.
Medial epicondylar fragments trapped within the joint do not require emergency surgery, but should be treated as soon as possible (no later than 24 hours from injury).
