Fracture Shaft of Humerus

A humerus fracture is an injury to the bone of the upper arm. The upper arm bone, the humerus, connects the shoulder to the elbow.

TYPES OF HUMERUS FRACTURE:

  • Proximal Humerus Fractures
    Proximal humerus fractures occur near the shoulder joint. The shoulder joint is a ball-and-socket joint, with the ball being the top of the humerus bone. Fractures of this ball are considered proximal humerus fractures. These fractures may involve the insertion of the important rotator cuff tendons. Because these tendons are important to shoulder motion, treatment may depend on the position of these tendon insertions.
  • Mid-Shaft Humerus Fractures
    Mid-shaft humerus fractures occur away from the shoulder and elbow joints. Most humeral shaft fractures will heal without surgery, but there are some situations that require surgical intervention. These injuries are commonly associated with injury to one of the large nerves in the arm, called the radial nerve. Injury to this nerve may cause symptoms in the wrist and hand (see below).
  • Distal Humerus Fractures
    Distal humerus fractures are uncommon injuries in adults. These fractures occur near the elbow joint. These fractures most often require surgical treatment unless the bones are held in proper position. This type of fracture is much more common in children, but the treatment is very different in this age group:

CAUSE : 

-bending force produces transverse fracture of the shaft;

-torsion force will result in a spiral fracture;
-combination of bending and torsion produce oblique fracture with or without a butterfly fragments.
-compression forces will fracture either proximal or distal ends of humerus

PATHO-ANATOMY:

A humerus can be considered a prototype fracture occurring in all patterns:

  • Transverse
  • Oblique
  • Spiral
  • Comminuted
  • Segmental
  • It can be open or closed ,traumatic or pathological.

DISPLACEMENT

  • Undisplaced
  • Marked angulation(mostly lateral)

DIAGNOSIS:

EXAMINATION:

Need to rule out radial nerve palsy, noting function of the ECRL/ECRB, EDC, ECU, EIP, and EPL;

IMAGING STUDIES:

Anteroposterior and lateral radiographs should be obtained first. These should be taken at 90° angles to each other. To obtain these radiographs, move the patient rather than rotate the injured limb through the fracture site. The shoulder and elbow should be included on each radiograph. Traction radiographs may be helpful with comminuted or severely displaced fractures, and comparison radiographs of the contralateral side may be helpful for determining preoperative length.

Computed tomography (CT) scanning is rarely indicated.

TREATMENT:

Non Operative Treatment of Humeral Shaft Fracture:

note that these injuries are often very painful and that good initial immobilization is required; long arm splint needs to be applied from shoulder to wrist to fully immobilize the extremity;
although rate of union is generally high with non operative treatment, incidence of mild malunion is high;
cast bracing:

can be used for most closed humeral shaft fracture;
in most cases, cast braces are applied at 10-12 days following injury;

forces displacing the fracture:

hanging casts:

may produce fracture distraction & may increase risk of nonunion;

Indications for Operative Treatment:

– unacceptable fracture position following closed reduction;
– new onset radial nerve palsy following closed reduction;
– multi-trauma patients;
– open humeral fractures;
– segmental humeral fractures;

– floating elbow or ipsilateral arm injuries;

pathologic fractures

Operative Treatment:

– internal fixation should be reserved for fractures with inadequate reduction or patients with multiple trauma;

IM Nailing of Humeral Shaft Fractures:
– External Fixation of Humeral Fracture
Plate Fixation:
anterior approach to humerus;
– posterior approach to humerus;

 

PHYSIOLINE’S SPECIALISED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Relieve pain
  • Reduce swelling
  • Reduce stiffness
  • Strengthening of muscles around wrist
  • Prevention of complications

 

Visit Physilone for the Consultation and treatment