Fractures of
Shaft of
Humerus
CONTENTS
✓ INTRODUCTION
✓ MECHANISM OF INJURY OF HUMERUS
✓ CLINICAL FEATURES
✓ INVESTIGATIONS
✓ TREATMENT
✓ COMPLICATION
INTRODUCTION
The humerus (arm bone) is the largest bone
of the upper extremity.
It articulates proximally with the glenoid via the
glenohumeral (GH) joint and distally with the radius
and ulna at the elbow joint.
Shaft is the longest part of the Humerus.
INTRODUCTION
The upper half of the shaft is roughly cylindrical and
begins to flatten in its lower half in the anteroposterior
direction
The fracture of shaft of humerus is also known as
diaphyseal fracture of the humerus.
Fracture at the shaft can occur in different ways –
Transverse, Oblique, Spiral, Comminuted, Segmental
ANATOMY
TYPES OF FRACTURES
MECHANISM OF FRACTURE
DIRECT MECHANISM:
By means of a blow on to the arm which results in a shattered
displaced fracture of the shaft of the humerus.
Ex. Assault by a stick, a high velocity injury
Birth injuries:
This is the second most common birth fracture after clavicle.
MECHANISM OF FRACTURE
INDIRECT MECHANISM:
By means of a fall on an out stretched hand.
✓ A bending force produces a transverse fracture.
✓ A tortional force produces a spiral fracture.
✓ A combination of both bending and tortional force
produces a comminuted fracture with a butterfly
fragment/fragments
MECHANISM OF FRACTURE
CLINICAL PRESENTATION
▪ Pain
▪ Swelling and bruising.
▪ Inability to move the shoulder
▪ A grinding sensation when the shoulder is moved
▪ Deformity - It does not look right
▪ Occasionally bleeding (open fracture)
▪ Loss of normal use of the arm if a nerve injury occurs.
▪ Any neurovascular injury (radial nerve - entrapped /
injured: wrist drop)
MANAGEMENT
1.CONSERVATIVE
Most of these fractures unite easily. Anatomical reduction is
not necessary as long as the fracture is stable.
a)U-slab : This is a plaster slab extending from the base of
the neck, over the shoulder onto the lateral aspect of the arm;
under the elbow to the medial side of the arm.
The U-slab is supported with a triangular sling. Once the
fracture unites, the slab is removed (approximately 6-8
weeks) and shoulder exercises started.
MANAGEMENT
(b) Hanging Cast
• It is used in some cases of lower-third fractures of
the humerus.
• The weight of the limb and the cast is supposed to
provide necessary traction to keep the fracture
aligned.
MANAGEMENT
(c) Chest-arm Bandage
• The arm is strapped to the chest.
• This much immobilization is sufficient for fracture of
the humerus in children less than five years of age.
MANAGEMENT
MANAGEMENT
SURGICAL
A) External fixation (Exfix)
B) Open reduction and internal fixation (ORIF)
C) Intramedullary nailing (IMN)
INTERNAL FIXATION EXTERNAL FIXATION
IMPLANTS
Implants used for surgery : various plates and
screws, DCP, LC-DCP, LCP.
Intramedullary nails including interlocking
nails.
Other nails include flexible nails like ENDERS,
AO, etc. External fixators are used in open
fractures
COMPLICATIONS
• Injury to the radial nerve (incomplete or
complete) –> HOLSTEIN – LEWIS Radial Nerve
Palsy
• Delayed union
• Nonunion
INTERCONDYLAR
FRACTURES
INTRODUCTION
• Common fracture in adults
• Results from a fall on the
point of the elbow so that the
olecranon is driven into the
distal humerus, splitting the
two humeral condyles apart.
• The fracture line may take
the shape of a T or Y.
CLINICAL PRESENTATION
• Severe pain
• Swelling
• Ecchymosis
• Crepitus
DIAGNOSIS • The diagnosis confirmed on X-rays
TREATMENT
• Depends upon the displacement.
• An Undisplaced fracture needs support in an above
–elbow plaster slab for 3-4 weeks, followed by
exercises.
• A displaced fracture is treated by open reduction
and internal fixation.
TREATMENT
COMPLICATIONS
• Stiffness of the elbow: Common complication because of
the intra-articular nature of this fracture. There may be
associated myositis ossificans. Treatment-
Physiotherapy.
• Malunion: Fracture may unite in a bad position, leads to
cubitus varus or valgus deformity. In severe deformities
corrective osteotomy may be required.
• Osteoarthritis: Pain and stiffness are presenting
symptoms. Treatment- Physiotherapy
THANK YO
