FRACTURE OF HUMERUS

Prepared by : Vinod Amity physiotherapy college Bpt 3rd year Roll no : 0071052607

Classification of fracture of humerus

1.

2.
3. 4. 5. 6. 7. 8.

# of the neck of the humerus # of the greater tuberosity # of the shaft Supracondylar # # of the condyles # sepration of lateral condylar epiphysis # of capitulum # of the epicondyles
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humerus fracture

Fracture neck of the humerus Type of fractures :

Undisplaced crack fracture Undisplaced spiral fracture Impacted adduction fracture Impacted abduction fracture Green-stick fracture Displaced humeral epiphysis with slight to moderate displacement

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

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humerus fracture

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Mechanism
Fall on the outstreatched hand Fall on the side

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Clinical feature
Pain Swelling Inability to move the part Arm 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
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Treatment
If no displacement occur reduction is unnecessary Collar sling ,cuff sling ,broad arm sling If # is Impacted patient start movt. early If # 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
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Contd.
After 4 weeks slings outside the clothes If un-impacted # with gross displacement reduction under anaesthesia If close reduction fails open reduction and internal fixation

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Option of internal fixation

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Joint replacement

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Complication
Stiffness Mal-union Nerve injury axillary nerve (rare) Associated with # of greater tuberosity Fracture-dislocation Pathological # Arterial injury

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Fracture of greater tuberosity

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

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Clinical feature
Patient presents with swollen and bruised shoulder following trauma Limitation of shoulder movement perticularly abduction On examination greater tuberosity is tender X-ray shows
i. Crack fracture of the tuberosity with no displacement
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Contd.
ii. Tuberosity may be comminuted iii. Tuberosity may be avulsed by supraspinatus tendon

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Treatment
1.

2. 3. 4.

In absence of displacement reduction is unnecessary . Arm is rested in a sling, active movement In case of # with displacement reduction is necessary Avulsion # close reduction The arm is abducted to 90, externally rotated for 60, and flexed for 40
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Contd.
5. 6.

7.
8.

Arm held in abducton frame for 6 weeks After this angle of frame lowered and is taken off at 12 weeks If closed reduction fails , open reduction with rush pin or screw Elbow and finger movement should be started
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Complication
Painful arc syndrome (supraspinatus syndrome)

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# of the shaft of the humerus

Mechanism 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 #
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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
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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
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Clinical 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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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

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Treatment
U-slab method Hanging cast method External splint Internal fixation

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Complication
1.

2.
3.

Radial nerve palsy Non union Joint stiffness

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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

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Mechanism
Extension type (99%) fall on out streched hand with elbow slightly flexed Displacement : distal fragment with forearm a) Pushed upward and backwards b) Backword angulation c) Twisted inward d) Slight shift to either medial or lateral side
1)
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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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AP view

Laterl view

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Clinical feature
Common # of childhood After 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
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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

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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
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Complication
Vascular injury

(vascular damage will lead to occulation of

the brachial artery and later on volkmanns ischaemic contracture)

Injury to nerve Joint stiffness Mal-union Myositis ossificans Cubitus varus

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fracture of the condyles of the humerus

Mechanism Fall on the point of the elbow

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Clinical feature
Swollen elbow Tenderness on the lower end of the humerus Unable to move the elbow

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Treatment
Undisplaced # manage by a posterior plaster slab with the elbow flexed(6weeks) Displaced # is reduced under anaesthesia Treatment without plastering Internal fixation

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Fracture of the lateral condylar epiphysis

Mechanism Child falls on the hand with a varus angulation of elbows displacement Undisplaced or grossly displaced A triangular fragment of metaphysis is attached to the epiphysis and rotation of the # fragment take place
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Clinical feature
Swollen elbow Tenderness on the lateral side of the elbow

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Treatment
Undisplaced # post. plaster slab with the elbow at 90 and wrist extended # with displacement close or open reduction Immobilisation Restitution of function

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Complication
Mal union Non union Cubitus valgus deformity Tardy ulnar palsy

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Fracture of capitulum
Mechanism Fall on the hand with the elbow straight

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Clinical feature
Swollen elbow perticularly in ant. part Tenderness around the elbow Unable to move the joint X-ray confirm diagnosis

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Treatment
Reduction close or open immobilisation

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Fracture of the medial epicondyle

Mechanism Fall on the hand with the elbow in abducted position

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clinical feature
Swllen elbow on medial side Tenderness is present in medial side Movt. of elbow almost impossible or and painful X-ray diagnose the condition

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Treatment
Same treatmet

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complication
Ulnar nerve damage Joint stiffness

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