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FRACTURE OF FRACTURE OF HUMERUSHUMERUS
Prepared by :Vinod
Amity physiotherapy collegeBpt 3rd year
Roll no : 0071052607
Classification of fracture of Classification of fracture of humerushumerus1. # of the neck of the humerus2. # of the greater tuberosity3. # of the shaft 4. Supracondylar # 5. # of the condyles6. # sepration of lateral condylar
epiphysis7. # of capitulum8. # of the epicondyles
31 Aug 09 2humerus fracture
31 Aug 09 3humerus fracture
Fracture neck of the Fracture neck of the humerus humerus
Type of fractures :Undisplaced crack fracture Undisplaced spiral fracture Impacted adduction fractureImpacted abduction fractureGreen-stick fractureDisplaced humeral epiphysis with slight to moderate displacement
31 Aug 09 4humerus fracture
Contd. Contd.
Fraction sepration of the epiphyses with a triangle of metaphyses Completely displaced fracture.
31 Aug 09 5humerus fracture
31 Aug 09 6humerus fracture
MechanismMechanism
Fall on the outstreatched handFall on the side
31 Aug 09 7humerus fracture
Clinical featureClinical featurePain SwellingInability to move the partArm becomes extensively bruised due to extravasation of blood from fracture Patient enters the clinic supporting the affected arm with the other hand .80% of # is undisplaced 20% of # is displaced X-ray shows the type of fracture
831 Aug 09 humerus fracture
31 Aug 09 9humerus fracture
31 Aug 09 humerus fracture 10
TreatmentTreatment If no displacement occur reduction is unnecessary Collar sling ,cuff sling ,broad arm sling If # is Impacted patient start movt. earlyIf # is non-impacted pt is not able to move the shoulder for first 2 weeks immobilisation After 2 weeks collar and cuff slings
worn under the clothes
31 Aug 09 11humerus fracture
Contd.Contd.
After 4 weeks slings outside the clothes If un-impacted # with gross displacement
reduction under anaesthesiaIf close reduction fails open reduction and internal fixation
31 Aug 09 12humerus fracture
31 Aug 09 humerus fracture 13
Option of internal Option of internal fixationfixation
Joint replacementJoint replacement
31 Aug 09 humerus fracture 14
ComplicationComplication StiffnessMal-union Nerve injury axillary nerve
(rare)Associated with # of greater
tuberosity Fracture-dislocationPathological # Arterial injury
31 Aug 09 15humerus fracture
Fracture of greater Fracture of greater tuberositytuberosityMechanism
Fall on the abducted armDirect injury by fall on the shoulder avulsion fracture may occur in young who try to save himself from falling
31 Aug 09 16humerus fracture
Clinical featureClinical featurePatient presents with swollen and bruised shoulder following traumaLimitation of shoulder movement perticularly abductionOn examination greater tuberosity is tenderX-ray shows
i. Crack fracture of the tuberosity with no displacement
31 Aug 09 17humerus fracture
Contd.Contd. ii. Tuberosity may be comminuted
iii. Tuberosity may be avulsed by supraspinatus tendon
31 Aug 09 humerus fracture 18
31 Aug 09 humerus fracture 19
Treatment Treatment
1. In absence of displacement reduction is unnecessary . Arm is rested in a sling, active movement
2. In case of # with displacement reduction is necessary
3. Avulsion # close reduction4. The arm is abducted to 90°,
externally rotated for 60°, and flexed for 40°
31 Aug 09 humerus fracture 20
Contd. Contd.
5. Arm held in abducton frame for 6 weeks
6. After this angle of frame lowered and is taken off at 12 weeks
7. If closed reduction fails , open reduction with rush pin or screw
8. Elbow and finger movement should be started
31 Aug 09 humerus fracture 21
ComplicationComplication Painful arc syndrome
(supraspinatus syndrome)
31 Aug 09 humerus fracture 22
# of the shaft of the # of the shaft of the humerushumerusMechanism
Fall on hand may twist the humerus and cause spiral #Fall on elbow with the arm abducted may hindge the bone cause oblique or transverse #Direct blow to the shaft of humerus cause transverse # with or without butterfly fragment or a comminuted #
31 Aug 09 humerus fracture 23
Types of #Types of #
1. Middle third spiral , slightly oblique , transverse, or comminuted. children green stick
displacement : proximal fragmemt abducted by
pull of deltoid muscles distal fragment is pull upward and
adducted by the pull of the biceps and triceps
31 Aug 09 humerus fracture 24
Contd.Contd.2. Upper third trauma,
pathological # e.g. Solitary bone cysts ,secondary carcinoma displacement :
(i) If the # is above the pectoralis major then proximal fragment abducted and internally rotated whereas distal segment is adducted
(ii) if the # is below the pectoralis major then proximal fragment is adducted whereas distal fragment is abducted
31 Aug 09 humerus fracture 25
Clinical featureClinical feature injured arm is flail and the patient
is usually supports it with the hand Tremendous pain in the middle of
the arm and swelling On examination definite bony
tenderness at the middle of the arm
Injury to radial nerve X-ray confirms the type of #
31 Aug 09 humerus fracture 26
31 Aug 09 humerus fracture 27
31 Aug 09 humerus fracture 28
Principles of treatment Principles of treatment Reduction of these # is
unnecessary , as gravity corrects any overlapping or angulation
Little shortening or overlapping may be accepted as this does not hamper normal function
Union
31 Aug 09 humerus fracture 29
Treatment Treatment U-slab methodHanging cast methodExternal splintInternal fixation
31 Aug 09 humerus fracture 30
Complication Complication
1. Radial nerve palsy2. Non union 3. Joint stiffness
31 Aug 09 humerus fracture 31
31 Aug 09 humerus fracture 32
31 Aug 09 humerus fracture 33
Supracondylar #Supracondylar #Definition: # line lies proximal to the
lower end of the humerus comprised of the trochlea and capitulum and may passes through the apices of the coronoid and olecranon fossae
31 Aug 09 humerus fracture 34
Mechanism Mechanism
1) Extension type (99%) fall on out streched hand with elbow slightly flexed
Displacement : distal fragment with forearm
a) Pushed upward and backwardsb) Backword angulation c) Twisted inward d) Slight shift to either medial or
lateral side31 Aug 09 humerus fracture 35
Contd.Contd.
2) Flexion type (1%) fall on hand with the elbow straight or fall on flexed elbow
Displacement : lower fragment is displaced upwards and forwards and tilted forward
31 Aug 09 humerus fracture 36
31 Aug 09 humerus fracture 37
AP AP viewview
31 Aug 09 humerus fracture 38
Laterl Laterl viewview
Clinical featureClinical feature
Common # of childhoodAfter injury the patient present with painful swollen elbow which remains flexed On examination
post. prominence of the point of the elbow
tenderness over the distal humerus
31 Aug 09 humerus fracture 39
Contd. Contd. Movt. of elbow restricted May be # itself may contuse the
brachial artery so that the distal circulation is occluded
Injury of the any of the three nerve : ulnar, median and radial nerve
31 Aug 09 humerus fracture 40
Treatement Treatement Undisplaced # are treated by
collar or cuff with the elbow flexed for 3 weeks
In case of green stick # with angulation >20° then treatment is manipulation under anaesthesia
In case of displaced # reduction must be done under anaesthesia
immobilisation
31 Aug 09 humerus fracture 41
Complication Complication
Vascular injury(vascular damage will lead to occulation
of the brachial artery and later on volkmann’s ischaemic contracture)
Injury to nerveJoint stiffnessMal-unionMyositis ossificansCubitus varus
31 Aug 09 humerus fracture 42
fracture of the condyles of the fracture of the condyles of the humerushumerus
Mechanism Fall on the point of the elbow
31 Aug 09 humerus fracture 43
Clinical featureClinical featureSwollen elbowTenderness on the lower end of
the humerusUnable to move the elbow
31 Aug 09 humerus fracture 44
Treatment Treatment Undisplaced # manage by a
posterior plaster slab with the elbow flexed(6weeks)
Displaced # is reduced under anaesthesia
Treatment without plasteringInternal fixation
31 Aug 09 humerus fracture 45
Fracture of the lateral condylar Fracture of the lateral condylar epiphysisepiphysis
Mechanism Child falls on the hand with a varus angulation of elbows
displacementUndisplaced or grossly displaced A triangular fragment of metaphysis is attached to the epiphysis and rotation of the # fragment take place
31 Aug 09 humerus fracture 46
Clinical featureClinical feature
Swollen elbowTenderness on the lateral side of the elbow
31 Aug 09 humerus fracture 47
Treatment Treatment Undisplaced # post. plaster
slab with the elbow at 90° and wrist extended
# with displacement close or open reduction
ImmobilisationRestitution of function
31 Aug 09 humerus fracture 48
ComplicationComplication Mal union Non union Cubitus valgus deformity Tardy ulnar palsy
31 Aug 09 humerus fracture 49
Fracture of capitulumFracture of capitulum
MechanismFall on the hand with the elbow straight
31 Aug 09 humerus fracture 50
Clinical featureClinical featureSwollen elbow perticularly in ant.
partTenderness around the elbow Unable to move the jointX-ray confirm diagnosis
31 Aug 09 humerus fracture 51
TreatmentTreatment Reduction close or openimmobilisation
31 Aug 09 humerus fracture 52
Fracture of the medial Fracture of the medial epicondyleepicondyleMechanism
Fall on the hand with the elbow in abducted position
31 Aug 09 humerus fracture 53
clinical featureclinical featureSwllen elbow on medial side Tenderness is present in medial
side Movt. of elbow almost impossible
or and painfulX-ray diagnose the condition
31 Aug 09 humerus fracture 54
Treatment Treatment Same treatmet
31 Aug 09 humerus fracture 55
complicationcomplicationUlnar nerve damageJoint stiffness
31 Aug 09 humerus fracture 56