1) Fractures of the humeral shaft can result from a fall on an outstretched hand or direct blow to the arm. 2) Treatment involves either hanging casts or surgery depending on the severity of the fracture and any complications. 3) Complications can include injury to the radial nerve and non-union of the bone fragments, so careful assessment of nerve function is important both before and after treatment.

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