Distal humeral fracture
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026A break of the upper arm bone at the elbow end. Most adults need surgery to fix this kind of break, and physiotherapy must start very early to prevent the elbow stiffening.
📊 This injury is uncommon in adults. It tends to happen in two groups: younger people after a heavy injury such as a road accident, and older people after a fall onto the elbow when the bone has weakened with age.
What is a distal humeral fracture?
This is a break of the lower end of the upper arm bone, where it forms the upper part of the elbow joint. The lower end of the bone is shaped a bit like a tuning fork, with two arms straddling the elbow joint. Breaks here usually involve both arms and run into the joint surface itself, which makes them tricky to repair.
Most of these breaks in adults need an operation. The surgeon usually fixes the broken pieces back together with two metal plates and screws, one along each side. The aim is to give a firm enough repair that you can start moving the elbow within days, which is the key to a good final result.
Even with a good operation and good physiotherapy, most people do not get back full straightening of the elbow. A final range of movement of around 100 degrees is common. This is less than normal range of motion but it is enough for most daily tasks. The elbow tends to stay slightly bent at rest.
Common causes
- Falls directly onto a bent elbow
- Higher-energy injuries such as road traffic accidents and sports collisions
- Falls in older people, especially where the bones have weakened with age
- Rarely, a break through bone weakened by previous surgery or by disease
Who is at risk? Two groups are most at risk: young adults caught in high-energy accidents, and older people with thinner bones. Smoking and diabetes can slow bone healing. Previous elbow surgery may make the repair more difficult.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Severe pain, swelling, and an obvious change in the shape of the elbow immediately after injury
- Inability to straighten or bend the elbow
- Bruising around the elbow, often spreading down the forearm
- Numbness or tingling in the fingers, particularly the little finger side
- Rarely, an open wound where the bone has broken through the skin (this needs emergency treatment)
When to seek help: Go to A&E straight away after a significant elbow injury. This can be a surgical emergency, especially if there is an open wound, if the hand looks pale or feels cold, or if the fingers go numb.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Examination of the elbow, the skin, and the nerves and blood vessels in the arm and hand
- Urgent X-rays of the elbow from the front and side
- A CT scan with 3D images, which is essential before surgery to plan the repair
- Checking the working of nearby nerves, particularly the ulnar nerve at the inside of the elbow (which controls feeling in the little finger)
CT scans showing the break in three dimensions have become a standard part of planning surgery for these injuries. They help the surgeon understand exactly how the bone has broken before opening up the elbow.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Surgery to fix the bone with metal plates
The standard treatment in most adults. The surgeon makes a cut at the back of the elbow, sometimes lifting the tip of the elbow bone out of the way to see the break properly. The broken pieces are put back together with two metal plates and screws, one along each side. The aim is a firm enough repair to start physiotherapy within a day or two.
Total elbow replacement
Where the lower end of the bone is shattered into too many pieces to rebuild, especially in older patients with low demands, replacing the elbow joint may give a faster and more reliable recovery. The replaced joint allows movement straight away, but there is a lifting limit afterwards (usually no more than around 2 to 5 kg).
Sling and early movement
If the broken pieces are in a very good position and have not shifted, a short period in a sling followed by early gentle movement may be possible. This is uncommon for adult elbow fractures and requires careful follow-up to make sure the pieces stay in place.
Recovery
This is one of the most difficult elbow injuries to recover from. Physiotherapy has to begin within a day or two of surgery to keep the elbow moving. Even with the very best care, most people are left with a small amount of elbow stiffness. The final range of movement is usually enough for daily activities, but the elbow may not fully straighten.
- Surgery: Within a few days of injury
- Physiotherapy starts: Day 1-5 after surgery
- Most pain settles: 6-12 weeks
- Maximum recovery: 6-18 months
What results can I expect?
Most people end up with a useful working elbow. Around 8 in 10 are pleased with the result, though most are left with some loss of straightening. Around 1 in 5 may need further surgery later, often to remove metalwork that is causing discomfort.
Lower upper arm fracture at the elbow - surgery and recovery
Common activity questions for this condition. Timelines are approximate, always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Drive | Months 2–3 | When elbow has adequate flexion and extension for steering and emergency stop. |
| Return to desk work | Weeks 4–6 | When elbow allows comfortable typing. Start with shorter sessions. |
| Manual work | Months 4–6 | Depending on final elbow movement and job demands. |
| Sport | Months 6–12 | Non-contact sport when movement and strength allow. Contact sport after full recovery. |
| Full elbow extension | Likely never | Full extension is rarely regained. A functional arc (30–130°) is the realistic goal, sufficient for most activities. |
Common concerns during recovery, and whether they are expected.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is a distal humerus fracture?
It is a break at the lower end of the upper-arm bone, right at the elbow. It often involves the joint surface and usually follows a fall. Because it is close to the elbow, stiffness afterwards is a particular concern.
Your choiceDo I need surgery?
Many of these breaks, especially when displaced or involving the joint, are fixed with plates and screws so the elbow can start moving early. Some stable breaks are managed without surgery. Your surgeon decides based on the fracture pattern and your needs.
Getting backWhat is recovery like?
Early, guided movement is important to avoid a stiff elbow. The bone heals over several weeks, but regaining a full bend and straightening can take several months of physiotherapy, and some loss of movement can remain.
StiffnessWhy is stiffness so common?
The elbow stiffens easily after injury and surgery. Sticking closely to your physiotherapy programme is the single most important thing you can do to regain movement.
Pain & medsHow do I manage pain and swelling?
Pain relief, keeping the arm elevated to settle swelling, and starting the gentle movements you are given all help in the early period.
UrgentWhen should I seek urgent help?
Numbness, tingling or weakness in the hand, a cold or pale hand, severe or increasing pain with tight swelling, or a wound becoming hot, red or discharging, all need prompt review.
PreparingHow do I prepare for surgery?
You will have a pre-assessment and anaesthetic review, and advice on any medicines. Arrange help at home, as you will likely begin guided movement soon after the operation.
WellbeingI am worried about ending up with a stiff elbow.
That is understandable. Early physiotherapy and a realistic timeline give the best chance of good movement. Raise any concerns about progress early so they can be addressed.
- NHS: Broken arm or wrist
- Versus Arthritis: Elbow pain
- British Elbow & Shoulder Society: Exercises for elbow stiffness
- British Elbow & Shoulder Society: Patient information
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Examination of the elbow, the skin, and the nerves and blood vessels in the arm and hand
- ✓Urgent X-rays of the elbow from the front and side
- ✓A CT scan with 3D images, which is essential before surgery to plan the repair
- ✓Checking the working of nearby nerves, particularly the ulnar nerve at the inside of the elbow (which controls feeling in the little finger)
Recovery milestones
- ●Surgery: Within a few days of injury
- ●Physiotherapy starts: Day 1-5 after surgery
- ●Most pain settles: 6-12 weeks
- ●Maximum recovery: 6-18 months