Fracture of Humerus

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

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


Contd. Contd.

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


MechanismMechanism

Fall on the outstreatched handFall on the side


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 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


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



Option of internal Option of internal fixationfixation

Joint replacementJoint replacement


ComplicationComplication StiffnessMal-union Nerve injury axillary nerve

(rare)Associated with # of greater

tuberosity Fracture-dislocationPathological # Arterial injury


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


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


Contd.Contd. ii. Tuberosity may be comminuted

iii. Tuberosity may be avulsed by supraspinatus tendon


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°


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


ComplicationComplication Painful arc syndrome

(supraspinatus syndrome)


# 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 #


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


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


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 #


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


Treatment Treatment U-slab methodHanging cast methodExternal splintInternal fixation


Complication Complication

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


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


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


AP AP viewview


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


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


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


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


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

Mechanism Fall on the point of the elbow


Clinical featureClinical featureSwollen elbowTenderness on the lower end of

the humerusUnable to move the elbow


Treatment Treatment Undisplaced # manage by a

posterior plaster slab with the elbow flexed(6weeks)

Displaced # is reduced under anaesthesia

Treatment without plasteringInternal fixation


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


Clinical featureClinical feature

Swollen elbowTenderness on the lateral side of the elbow


Treatment Treatment Undisplaced # post. plaster

slab with the elbow at 90° and wrist extended

# with displacement close or open reduction

ImmobilisationRestitution of function


ComplicationComplication Mal union Non union Cubitus valgus deformity Tardy ulnar palsy


Fracture of capitulumFracture of capitulum

MechanismFall on the hand with the elbow straight


Clinical featureClinical featureSwollen elbow perticularly in ant.

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


TreatmentTreatment Reduction close or openimmobilisation


Fracture of the medial Fracture of the medial epicondyleepicondyleMechanism

Fall on the hand with the elbow in abducted position


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


Treatment Treatment Same treatmet


complicationcomplicationUlnar nerve damageJoint stiffness


Fracture of Humerus

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