After completion of this session, students should be able to discuss, identify, and describe: The anatomical factors predisposing to the etiology of a fracture or dislocation. The anatomy of displacement or deformity. Imaging anatomy features and how to differentiate from epiphyseal lines. Anatomy related to correct relocation and alignment. Anatomical complications of a fracture or dislocation.

1. Dr.AkramJaffar
Imaging Anatomy of Fractures and Dislocations inImaging Anatomy of Fractures and Dislocations in
the Upper Limbthe Upper Limb
Fractures of the humerusFractures of the humerus
Akram Jaffar, Ph.D.
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References and suggested reading
• Ellis H (2006): Clinical anatomy, A revision and applied anatomy for clinical students.
11th
Ed. Blackwell Publishing. Massachusetts.
• Moore KL et al. (2013): Clinically Orientated Anatomy. 7th Ed. Lippincott, Williams &
Wilkins. Philadelphia.
• Hamblen DL & Simpson HRW (2007): Adam’s outline of fractures including joint
injuries. 12th
ed. Churchill Livingstone Elsevier. Edinburgh.
• Solomon L, Warwick DJ & Nayagam S (2001): Apley's System of Orthopedics and
Fractures. 8th ed. Arnold Publishing.

3. Dr.AkramJaffar
Objectives
After completion of this session, students should be able to discuss, identify, and describe:
• The anatomical factors predisposing to the etiology of a fracture or dislocation.
• The anatomy of displacement or deformity.
• Imaging anatomy features and how to differentiate from epiphyseal lines.
• Anatomy related to correct relocation and alignment.
• Anatomical complications of a fracture or dislocation.

4. Dr.AkramJaffar
• Anatomical complications: Three major nerves
in the arm are related to the humerus and are in
danger of injury in fractures of the humerus:
1. Axillary nerve: In fractures involving the surgical
neck
2. Radial nerve: In fractures involving the spiral
groove
3. Ulnar nerve: In fractures involving the medial
epicondyle
Fractures of the humerus
Axillary n.
Radial n.
Ulnar n.
Surgical neck
Spiral groove
Medial
epicondyle

5. Dr.AkramJaffar
• Radiographic features.
Fractures of the humerus
Surgical neck fracture Medial epicondyle fracture Spiral groove fracture

6. Dr.AkramJaffar
Humerus upper end ossification centres
• At the head during the 1st
year
• At the greater tuberosity at the 3rd
year
• At the lesser tuberosity by the 5th
year
7 months
4 years
1y 3y 5y
head
Greater tuberosity

7. Dr.AkramJaffar
Humerus upper end ossification centres
• The three centres fuse by the 7th
year into a
single epiphysis
• The epiphysial line (2) is hollowed to fit a
conical projection of the bony shaft
• Fusion occurs by 20 years head
coracoid
clavicle
acromian
2

8. Dr.AkramJaffar
Fracture of humeral shaft
• Anatomy of displacement: depends on the relation of
the site of the fracture to the insertion of deltoid muscle
• When the fracture is distal to deltoid insertion
• The proximal fragment is abducted by deltoid.
• The distal fragment is pulled proximally by biceps
and triceps.
deltoid
biceps
triceps

9. Dr.AkramJaffar
Fracture of humeral shaft
• Anatomy of displacement: When the
fracture is proximal to deltoid insertion
• the proximal fragment is adducted
by muscles of the intertubercular
groove and its lips.
• the distal fragment is pulled
upwards by deltoid, biceps, triceps,
and coracobrachialis.
• the distal fragment is also pulled
outwards by deltoid.
deltoid
Pectoralis major
Latissimus dorsi

10. Dr.AkramJaffar
Supracondylar fracture
• Anatomy of displacement:
– The injuring force carries the condyles
backward
– The lower end of the proximal fragment is
carried forward and downward
• Anatomical complications:
– The brachial artery and median and radial
nerves may become compressed by fragments
of bone and by blood that infiltrates the cubital
fossa from bleeding resulting from stripping of
Injury of the periosteum.
Brachial a.
Radial n.
Median n.
Humeral
condyles
radius ulna

11. Dr.AkramJaffar
• Anatomical complications:
• Volkmann’s contracture:
When the collateral circulation cannot compensate
for occlusion of the brachial artery  ischemia of
flexor muscles of the forearm  necrosis  muscle
will be replaced by fibrous tissue  muscle will
become thin and shortened  flexion deformity of
the wrist and fingers (Volkmann’s ischemic
contracture).
Supracondylar fracture
Anastomosis
around the elbow