DESCRIBE AND DISCUSS THE MECHANISM OF INJURY.
CLINICAL FEATURES, INVESTIGATIONS AND
PRINCIPLES OF MANAGEMENT OF FRACTURE OF
SHAFT OF HUMERUS AND INTERCONDYLAR
FRACTURE HUMERUS WITH EMPHASIS ON
NEUROVASULAR DEFICIT
By – Roll no 40-
Fracture of the shaft of
humerus
This is a common fracture in patients at any age. It is
usually sustained from an indirect twisting or bending force-
as may be sustained in a fall on outstretched hand or by a
direct injury to the arm
Clinical Anatomy
The humeral shaft extends from below the surgical neck of
the humerus to above the supracondylar ridge.
Important anatomical relations:
Radial nerve: spirals around the posterior surface in the
radial (spiral) groove, especially at the junction of the
middle and distal third—making it vulnerable to injury.
Brachial artery lies medially in the lower third.
Mechanism of Injury
A humerus fracture can
be considered a
prototype fracture
because it occurs in all
patterns (transverse,
oblique, spiral,
comminuted, segmental,
etc.), may be closed or
open, and may be
traumatic or pathological
Mechanism of Injury
Displacements are variable. It
may be an undisplaced
fracture, or there may be
marked angulation or
overlapping of fragments.
Lateral angulation is common
because of the abduction of
the proximal fragment by the
deltoid muscle
Fig – Displacement in fracture shaft of the Humerus
Clinical features
1.Pain – Sudden, localized in the mid-arm
2. Swelling – Around the fracture site
3. Deformity – Visible angulation or shortening
4. Tenderness – On palpation at the fracture site
5. Crepitus – Grating sensation on movement
6. Loss of function – Inability to move the arm
7. Radial nerve involvement – Wrist drop, sensory loss on dorsum of
Investigations
X-ray
AP (Anteroposterior) and Lateral views of the entire
humerus, including shoulder and elbow joint
It Confirm fracture & Identify fracture pattern (transverse,
oblique, spiral, comminuted, etc.)
Assess displacement, angulation, or segmental involvement
CT Scan (i.e- Complex or comminuted fractures ,
Suspected intra-articular extension) and MRI If needed
Treatment
Non-Operative Treatment : Indicated in closed, minimally
displaced, or simple fractures
• U Slab – for 6-8weeks , 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. It should be moulded on the lateral side of the arm in
order to prevent lateral angulation
• Then transition to functional brace (Sarmiento brace)
• Hanging cast- For lower-third fractures of the humerus
• Chest-arm bandage: The arm is strapped to the chest.
Treatment
Operative Treatment : Indicated in closed, minimally
displaced, or simple fractures
1. Open Reduction and Internal Fixation (ORIF) with plate and
screws
2.Intramedullary nailing (especially in segmental or pathological
fractures)
Complications
1.Radial Nerve Injury (most common) ~10–18% in closed
fracture ; Results in wrist drop, sensory loss over dorsum of the
hand ; Most recover spontaneously (neuropraxia)
• Surgical exploration if no recovery after 3–4 months or if injury
occurs after manipulation
2. Nonunion ;Failure of fracture to unite after 6 months
Causes: inadequate immobilization, distraction at fracture site,
infection, poor blood supply
May require bone grafting and internal fixation
Intercondylar Fracture of Humerus
• A fracture involving the distal humerus, where the fracture
line extends into the elbow joint, splitting the humerus
between the medial and lateral condyles, forming a T or Y-
shaped pattern.
• Common fracture in adults
• AO Classification –
• T-type: Commonest, vertical fracture line splits condyles
with transverse proximal line
• Y-type: Like T-type but less transverse involvement
• H-type (rare variants)
Mechanisms of injury
• The fracture is generally badly comminuted and displaced.
When displaced, the two condyles fall apart and are rotated
along their horizontal axis
Commonly due to fall on an outstretched hand with the elbow
flexed
Direct blow to the posterior elbow in flexion
• High-energy trauma (e.g., RTA)
Investigations
• X-ray: AP and Lateral views
of the elbow (shows
intercondylar extension)
Clinical features
• There is generally severe
pain, swelling, ecchymosis
and crepitus around the
elbow
Treatment
Non Operative Treatment : An undisplaced fracture
needs support in an above-elbow plaster slab for 3-4 weeks,
followed by exercises
Operative Treatment :
Open Reduction & Internal Fixation –
• Bicolumnar plating (medial + lateral column)
• Anatomic reduction of articular surface
• Olecranon osteotomy often used for better exposure
• Early mobilization post-surgery is essential
X-rays of the
elbow, AP and
lateral views,
showing an
intercondylar
fracture
reconstructed
with plates
and screws
Complications
1.Elbow Stiffness (most common) Due to prolonged
immobilization, intra-articular involvement, and soft tissue
scarring may associate with myositis ossificans (Benign tumor )
Treatment by physiotherapy
2. Malunion ; fracture may unite in bad position, leads to
cubitus varus Or valgus deformity ; corrective osteotomy may
required
3. Osteoarthritis - due to imperfect reduction or articular
Neurovascular deficit
1.Ulnar Nerve Injury (Most common)
Course: Passes behind the medial epicondyle, very close to the
fracture line
Mechanism: •Direct trauma from displaced fragment
•Stretching or entrapment during injury
•Iatrogenic during surgical exposure (esp. Olecranon osteotomy)
• Clincal sign - Weakness of intrinsic hand muscles , Sensory
loss in little finger and medial half of ring finger ,Claw hand (late
stage)
2. Median Nerve Injury ; Weak thumb opposition and
finger flexion
