Shaft of humerus fracture by Dr Bipul Borthakur

1. SHAFT OF HUMERUS

2. INTRODUCTION-ANATOMY

3. INTRODUCTION –NERVES IN RELATION

4. INTRODUCTION-NERVES IN RELATION

5. FRACTURE SHAFT OF HUMERUS
 MECHANISM OF INJURY:-
 A FALL ON HAND-May twist the Humerus-Causes Spiral fracture
 A FALL ON ELBOW WITH ARM ABDUCTED-Exerts a bending force-
Causes an Oblique or Transverse fracture
 A DIRECT BLOW TO ARM- Transverse or Comminuted fracture

6. FRACTURE SHAFT OF HUMERUS
 PATHOANATOMY:-
1)For fractures above deltoid insertion – proximal fragment is adducted
by pectoralis major
2)For fractures below deltoid insertion – proximal fragment is abducted
by Deltoid
3)Injury to Radial nerve is common – Fortunately recovery is usual

7. FRACTURE SHAFT OF HUMERUS
 CLINICAL FEATURES:-
Arm will be: Painful
Swollen
Bruised

8. FRACTURE SHAFT OF HUMERUS
CLINICAL FEATURES Contd..
 Radial nerve function testing before and after treatment is important
 How to do? - By assessing active extension of the metacarpo
phalangeal joints
 Why not active extension of wrist?
It can be misleading because extensor carpi radialis longus is
sometimes supplied by a branch arising proximal to injury

9. FRACTURE SHAFT OF HUMERUS
 X-RAYS:- AP and lateral view of arm with shoulder
and elbow joint
Shows - Site of fracture
- Pattern -Transverse
-Spiral
-Comminuted
- Displacement
 USG of arm – to detect the radial continuity or
entrapment

10. FRACTURE SHAFT OF HUMERUS
 Non- Operative treatment:
• Fracture shaft of Humerus heals readily normally.
• The weight of arm with an external cast is usually enough
HANGING CAST:-
 Applied from shoulder to wrist, with elbow flexed 90 degrees
 The forearm section is surrounded by a sling around patients neck
 This may be replaced by a shortcast (shoulder to elbow) or a
polypropylene brace later

11. FRACTURE SHAFT OF HUMERUS
 HANGING CAST:-

12. FRACTURE SHAFT OF HUMERUS
 ADVANTAGES OF NON-OPERATIVE TREATMENT:-
 Wrist and finger exercises can be done easily
 Pendulum exercises of shoulder can be started within a week.

13. FRACTURE SHAFT OF HUMERUS
 Operative treatment:-
 Indications: - Severe multiple injuries
- An Open fracture
- Segmental fractures
- Displaced intra-articular extension
- A Pathological fracture
- A Floating elbow
- Radial nerve palsy after -
manipulation
- Nonunion
- Problem with nursing care in a-
dependend person

14. FRACTURE SHAFT OF HUMERUS
 Fixation can de done with:-
• Compression plate and screws
• Interlocking intramedullary nail or semi flexible pins
• An external fixation

15. FRACTURE SHAFT OF HUMERUS
 COMPRESSION PLATE AND SCREWS:-

16. FRACTURE SHAFT OF HUMERUS
 COMPRESSION PLATE AND SCREWS:-
 ADVANTAGES:-
1. Excellent reduction and fixation
2. Doesn’t interfere with shoulder and elbow function
 DISADVANTAGES:-
1. Possibility of Radial nerve injury
2. Too much periosteal stripping may increase the risk of Nonunion

17. FRACTURE SHAFT OF HUMERUS
 INTERLOCKING INTRAMEDULLARY NAIL:-

18. FRACTURE SHAFT OF HUMERUS
 INTERLOCKING INTRAMEDULLARY NAIL:-
 ADVANTAGES:-
1. Requires minimal dissection
 DISADVANTAGES:-
1. Causes Rotator cuff problems
2. It may distract the fracture

19. FRACTURE SHAFT OF HUMERUS
 EXTERNAL FIXATION:-

20. FRACTURE SHAFT OF HUMERUS
 EXTERNAL FIXATION:-
 ADVANTAGES:-
1. Useful in high energy Segmental fractures and Open fractures
 DISADVANTAGES:-
1. Possibility of Radial nerve injury

21. FRACTURE SHAFT OF HUMERUS
COMPLICATIONS
 EARLY
a) Vascular injury- Brachial artery
b) Nerve injury- Radial nerve (particularly in oblique fractures at the jn of
middle and distal 1/3rd of bone ie Holstein- Lewis fracture)
 LATE
a) Delayed union and Non-union(Typical in segmental high energy
fractures and open fractures)
b) Joint stiffness

22. FRACTURE SHAFT OF HUMERUS
 HOLSTEIN-LEWIS FRACTURE:-

23. FRACTURE SHAFT OF HUMERUS
 SPECIAL FEATURES IN CHILDREN:-
- Uncommon in under 3 years of age
- If present, possibility of child abuse to be considered and tactful
examination needed.
 TREATMENT- Conservative