Fractures of the humerus shaft and intercondylar fractures of the elbow are discussed. Humerus shaft fractures make up 3-5% of all fractures and have bimodal age distribution in the 3rd and 7th decades. Clinical features include pain, swelling, deformity. Radiographs are used to identify the location and pattern of fractures. Treatment depends on if the fracture is open or closed, displaced or not. Complications can include radial nerve palsy, nonunion, and stiffness. Intercondylar fractures commonly result from a fall onto the elbow and are often comminuted and displaced, requiring open reduction and fixation.

1. FRACTURE OF HUMERUS SHAFT
AND INTERCONDYLAR FRACTURE

2. INDEX
• EPIDEMIOLOGY
• ANATOMY
• PATHO ANATOMY
• MECHANISM OF INJURY
• CLINICAL FEATURES
• DIAGNOSIS
• TREATMENT
• COMPLICATIONS

3. EPIDEMIOLOGY
• 3 - 5% of all fractures
• Incidence – 14.5 per 1,00,000 per year
• 2-10% - open fractures
• 60% - mid 1/3rd
• 30 % - proximal 1/3rd
• 10% - distal 1/3rd
• Bimodal age distribution :
3rd decade - men,
7th /8th decade - women

4. ANATOMY
• Extend from pectoralis major insertion to
supracondylar ridge
• Cross section – cylindrical (proximal) to
triangular (distal)
• Blood supply perforating branches of
brachial artery
• Main nutrient artery enters through medial
humerus distal to midshaft

5. NERVES
• Radial nerve :
14-15 cm proximal to lateral
epicondyle or 20cm proximal to
medial epicondyle

6. Neurovascular
anatomy

7. ELBOW JOINT
• Hinge joint
• Humero-ulnar joint
• Humero-radial joint
• Lower end of humerus
enlarged to form trochlea
medially and capitulum
laterally

8. • 3 point bony relationship

9. Carrying angle

10. Ossification around
elbow

11. MECHANISM OF INJURY
• Direct (M/C) : blow/RTA –
transverse / comminuted #
• Indirect
Fall on out stretched hand –
elderly  transverse/oblique#
Throwing injuries with extreme
muscle contraction and arm
wrestling with rotational forces 
spiral #

13. Clinical features
• Pain
• Swelling
• Deformity
• Shortening in arm
• bruise
• Crepitus
• Gross motion

14. • Radial nerve examination before
and after # reduction – important
• Check for active MCP extension
• Active Wrist extension – often
misleading because FCRL is
sometime supplied by branch
proximal to injury

15. RADIOGRAPHY
• Xray humerus with shoulder and elbow - AP, Lateral views
• Transthoracic lateral
• Look for : site, pattern, displacement
• CT/MRI : done for pathological #

16. CLASSIFICATION
• Open fracture
• closed fracture

17. Location :
• Proximal third
• Mid third
• Distal third

18. Pattern

19. Intrinsic condition of bone
• Normal
• Osteopenic
• Pathologic
Displacement
• Displaced
• Undisplaced

20. TREATMENT
Non operative
90 % unite with non surgical
management
U slab application

21. HANGING CAST
• Dependency traction by weight of arm
and cast
• Spiral / oblique fracture
• Relative C/I : transverse due to potiential
for distraction and healing complications
• Patient should be upright / semi upright
at all time with cast in dependant
position

22. FUNCTIONAL BRACAING
• Exchanged with functional bracing with
early callus formation

23. OPERATIVE METHODS
• Open reduction and internal fixation with Compression plates and
screws

24. • Closed reduction and internal fixation with intramedullary nailing

25. Closed reduction and external fixation

26. COMPLICATIONS
1) Nerve injury
Radial nerve (M/C)
Neuropraxia  at time of fracture / during
manipulation / during fracture healing (nerve
entrapment in callus)

27. HOLSTEIN LEWIS FRACTURE
• Spiral #
• Junction of mid 1/3rd and distal 1/3rd
• Associated with radial nerve palsy
• Wrist drop / finger drop
• Wrist extensors/ finger extensor/
brachioradialis / supinator – paralysed
• Sensory change in dorsal aspect of 1st web
space

28. Treatment
• Most closed # - nerve recovers spontaneously
• Open # - exploration
• Neglected cases – tendon transfer
• Modified jones transfer – popular
• Forearm muscles supplied by median and ulnar nerves – substitute
wrist and finger extension, thumb abduction-extension

29. •Pronator teres  Extensor carpi radialis brevis
•Flexor carpi ulnaris  extensor digitorum
•Palmaris longus  extensor pollicis longus

30. 2) brachial artery injury
3) non union/ delayed union
Due to inadequate immobilisation
Distraction at # site due to gravity

31. INTERCONDYLAR HUMERUS FRACTURE
•Common # in adults
•Fall on elbow  olecranon
driven into distal humerus 
split condyles apart

32. PATHO ANATOMY : Often badly comminuted and displaced
T-type
Y-type

33. DIAGNOSIS
• Swelling, pain, tenderness , crepitus ,echymosis around elbow
• Xray elbow – AP and Lateral view

34. TREATMENT
• Undisplaced  Above elbow
slab x 3-4 weeks f/b exercise
• Displaced  open reduction
and internal fixation
• Severe comminution 
olecranon pin traction to reduce
and maintain reduction

35. COMPLICATIONS
• Stiffness of elbow – common because of intra articular nature
Rx : physiotherapy
• Myositis ossificans
• Malunion  cubitus varus/valgus deformity
Rx : corrective osteotomy for severe deformities
• osteoarthritis

36. THANK YOU