FRACTURE OF FRACTURE OF HUMERUSHUMERUS

Prepared by :Vinod

Amity physiotherapy collegeBpt 3rd year

Roll no : 0071052607

Classification of fracture of Classification of fracture of humerushumerus1. # of the neck of the humerus2. # of the greater tuberosity3. # of the shaft 4. Supracondylar # 5. # of the condyles6. # sepration of lateral condylar

epiphysis7. # of capitulum8. # of the epicondyles

31 Aug 09 2humerus fracture

31 Aug 09 3humerus fracture

Fracture neck of the Fracture neck of the humerus humerus

Type of fractures :Undisplaced crack fracture Undisplaced spiral fracture Impacted adduction fractureImpacted abduction fractureGreen-stick fractureDisplaced humeral epiphysis with slight to moderate displacement

31 Aug 09 4humerus fracture

Contd. Contd.

Fraction sepration of the epiphyses with a triangle of metaphyses Completely displaced fracture.

31 Aug 09 5humerus fracture

31 Aug 09 6humerus fracture

MechanismMechanism

Fall on the outstreatched handFall on the side

31 Aug 09 7humerus fracture

Clinical featureClinical featurePain SwellingInability to move the partArm becomes extensively bruised due to extravasation of blood from fracture Patient enters the clinic supporting the affected arm with the other hand .80% of # is undisplaced 20% of # is displaced X-ray shows the type of fracture

831 Aug 09 humerus fracture

31 Aug 09 9humerus fracture

31 Aug 09 humerus fracture 10

TreatmentTreatment If no displacement occur reduction is unnecessary Collar sling ,cuff sling ,broad arm sling If # is Impacted patient start movt. earlyIf # is non-impacted pt is not able to move the shoulder for first 2 weeks immobilisation After 2 weeks collar and cuff slings

worn under the clothes

31 Aug 09 11humerus fracture

Contd.Contd.

After 4 weeks slings outside the clothes If un-impacted # with gross displacement

reduction under anaesthesiaIf close reduction fails open reduction and internal fixation

31 Aug 09 12humerus fracture

31 Aug 09 humerus fracture 13

Option of internal Option of internal fixationfixation

Joint replacementJoint replacement

31 Aug 09 humerus fracture 14

ComplicationComplication StiffnessMal-union Nerve injury axillary nerve

(rare)Associated with # of greater

tuberosity Fracture-dislocationPathological # Arterial injury

31 Aug 09 15humerus fracture

Fracture of greater Fracture of greater tuberositytuberosityMechanism

Fall on the abducted armDirect injury by fall on the shoulder avulsion fracture may occur in young who try to save himself from falling

31 Aug 09 16humerus fracture

Clinical featureClinical featurePatient presents with swollen and bruised shoulder following traumaLimitation of shoulder movement perticularly abductionOn examination greater tuberosity is tenderX-ray shows

i. Crack fracture of the tuberosity with no displacement

31 Aug 09 17humerus fracture

Contd.Contd. ii. Tuberosity may be comminuted

iii. Tuberosity may be avulsed by supraspinatus tendon

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31 Aug 09 humerus fracture 19

Treatment Treatment

1. In absence of displacement reduction is unnecessary . Arm is rested in a sling, active movement

2. In case of # with displacement reduction is necessary

3. Avulsion # close reduction4. The arm is abducted to 90°,

externally rotated for 60°, and flexed for 40°

31 Aug 09 humerus fracture 20

Contd. Contd.

5. Arm held in abducton frame for 6 weeks

6. After this angle of frame lowered and is taken off at 12 weeks

7. If closed reduction fails , open reduction with rush pin or screw

8. Elbow and finger movement should be started

31 Aug 09 humerus fracture 21

ComplicationComplication Painful arc syndrome

(supraspinatus syndrome)

31 Aug 09 humerus fracture 22

# of the shaft of the # of the shaft of the humerushumerusMechanism

Fall on hand may twist the humerus and cause spiral #Fall on elbow with the arm abducted may hindge the bone cause oblique or transverse #Direct blow to the shaft of humerus cause transverse # with or without butterfly fragment or a comminuted #

31 Aug 09 humerus fracture 23

Types of #Types of #

1. Middle third spiral , slightly oblique , transverse, or comminuted. children green stick

displacement : proximal fragmemt abducted by

pull of deltoid muscles distal fragment is pull upward and

adducted by the pull of the biceps and triceps

31 Aug 09 humerus fracture 24

Contd.Contd.2. Upper third trauma,

pathological # e.g. Solitary bone cysts ,secondary carcinoma displacement :

(i) If the # is above the pectoralis major then proximal fragment abducted and internally rotated whereas distal segment is adducted

(ii) if the # is below the pectoralis major then proximal fragment is adducted whereas distal fragment is abducted

31 Aug 09 humerus fracture 25

Clinical featureClinical feature injured arm is flail and the patient

is usually supports it with the hand Tremendous pain in the middle of

the arm and swelling On examination definite bony

tenderness at the middle of the arm

Injury to radial nerve X-ray confirms the type of #

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31 Aug 09 humerus fracture 27

31 Aug 09 humerus fracture 28

Principles of treatment Principles of treatment Reduction of these # is

unnecessary , as gravity corrects any overlapping or angulation

Little shortening or overlapping may be accepted as this does not hamper normal function

Union

31 Aug 09 humerus fracture 29

Treatment Treatment U-slab methodHanging cast methodExternal splintInternal fixation

31 Aug 09 humerus fracture 30

Complication Complication

1. Radial nerve palsy2. Non union 3. Joint stiffness

31 Aug 09 humerus fracture 31

31 Aug 09 humerus fracture 32

31 Aug 09 humerus fracture 33

Supracondylar #Supracondylar #Definition: # line lies proximal to the

lower end of the humerus comprised of the trochlea and capitulum and may passes through the apices of the coronoid and olecranon fossae

31 Aug 09 humerus fracture 34

Mechanism Mechanism

1) Extension type (99%) fall on out streched hand with elbow slightly flexed

Displacement : distal fragment with forearm

a) Pushed upward and backwardsb) Backword angulation c) Twisted inward d) Slight shift to either medial or

lateral side31 Aug 09 humerus fracture 35

Contd.Contd.

2) Flexion type (1%) fall on hand with the elbow straight or fall on flexed elbow

Displacement : lower fragment is displaced upwards and forwards and tilted forward

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31 Aug 09 humerus fracture 37

AP AP viewview

31 Aug 09 humerus fracture 38

Laterl Laterl viewview

Clinical featureClinical feature

Common # of childhoodAfter injury the patient present with painful swollen elbow which remains flexed On examination

post. prominence of the point of the elbow

tenderness over the distal humerus

31 Aug 09 humerus fracture 39

Contd. Contd. Movt. of elbow restricted May be # itself may contuse the

brachial artery so that the distal circulation is occluded

Injury of the any of the three nerve : ulnar, median and radial nerve

31 Aug 09 humerus fracture 40

Treatement Treatement Undisplaced # are treated by

collar or cuff with the elbow flexed for 3 weeks

In case of green stick # with angulation >20° then treatment is manipulation under anaesthesia

In case of displaced # reduction must be done under anaesthesia

immobilisation

31 Aug 09 humerus fracture 41

Complication Complication

Vascular injury(vascular damage will lead to occulation

of the brachial artery and later on volkmann’s ischaemic contracture)

Injury to nerveJoint stiffnessMal-unionMyositis ossificansCubitus varus

31 Aug 09 humerus fracture 42

fracture of the condyles of the fracture of the condyles of the humerushumerus

Mechanism Fall on the point of the elbow

31 Aug 09 humerus fracture 43

Clinical featureClinical featureSwollen elbowTenderness on the lower end of

the humerusUnable to move the elbow

31 Aug 09 humerus fracture 44

Treatment Treatment Undisplaced # manage by a

posterior plaster slab with the elbow flexed(6weeks)

Displaced # is reduced under anaesthesia

Treatment without plasteringInternal fixation

31 Aug 09 humerus fracture 45

Fracture of the lateral condylar Fracture of the lateral condylar epiphysisepiphysis

Mechanism Child falls on the hand with a varus angulation of elbows

displacementUndisplaced or grossly displaced A triangular fragment of metaphysis is attached to the epiphysis and rotation of the # fragment take place

31 Aug 09 humerus fracture 46

Clinical featureClinical feature

Swollen elbowTenderness on the lateral side of the elbow

31 Aug 09 humerus fracture 47

Treatment Treatment Undisplaced # post. plaster

slab with the elbow at 90° and wrist extended

# with displacement close or open reduction

ImmobilisationRestitution of function

31 Aug 09 humerus fracture 48

ComplicationComplication Mal union Non union Cubitus valgus deformity Tardy ulnar palsy

31 Aug 09 humerus fracture 49

Fracture of capitulumFracture of capitulum

MechanismFall on the hand with the elbow straight

31 Aug 09 humerus fracture 50

Clinical featureClinical featureSwollen elbow perticularly in ant.

partTenderness around the elbow Unable to move the jointX-ray confirm diagnosis

31 Aug 09 humerus fracture 51

TreatmentTreatment Reduction close or openimmobilisation

31 Aug 09 humerus fracture 52

Fracture of the medial Fracture of the medial epicondyleepicondyleMechanism

Fall on the hand with the elbow in abducted position

31 Aug 09 humerus fracture 53

clinical featureclinical featureSwllen elbow on medial side Tenderness is present in medial

side Movt. of elbow almost impossible

or and painfulX-ray diagnose the condition

31 Aug 09 humerus fracture 54

Treatment Treatment Same treatmet

31 Aug 09 humerus fracture 55

complicationcomplicationUlnar nerve damageJoint stiffness

31 Aug 09 humerus fracture 56