Humeral Fracture

Humerus

Proximal Humeral Fracture

Mechanism

·                 young: high energy trauma (MVA)

·                 older: FOOSH from standing height in osteoporotic .individuals

Clinical Futures

·                 pain, swelling, tenderness, painful ROM

Investigations

·                 test a:xillary nerve function (deltoid function and skin over deltoid)

·                 x-rays: AP, trans-scapular, uiliary are essential

·                 CT scan: to evaluate for articular involvement and fracture displacement

Classification

·                 Neer classification is based on 4 fracture fragments: head, greater tuberosity, lesser tuberosity, shaft

 • nondisplaced: displacement <1 cm and/or angulation <45°

 • displaced: displacement >1 cm and/or angulation >45°

 • dlslocated/subluxed: humeral head dislocated/subbluxed from glenoid

Treatment

·                 non-operative

 • sling immobilization (nondlsplaced): begin ROM in 7-10 days to prevent stiffness

 • closed reduction (minimally displaced)

·                 operative

 • ORIF (anatomic neck fractures, displaced. dislocated)

 • hemiarthroplasty may be necessary, especially in elderly

Specific Complications (see General Fracture Complications)

·                 AVN, axillary nerve palsy, malunion, post-traumatic arthritis

Humeral Shaft Fracture

Mechanism

·                 direct blows/MVA (most common), FOOSH, twisting injuries, metastases (in elderly)

Clinical Features

·                 pain, swelling,± shortening. mot:lon/aepitus at fracture site

·                 must test ra.d1al. nerve function before and after treatment

Investigations

·                 x-rays: AP and lateral radiographs of the humerus including the shoulder and elbow joints

Treatment

·                 in general. humeral shaft fractures are t:n:ab:d non-operatively

·                 non-operative (most common)

o       ± reduction- am accept deformity due to compensatory range of motion of shoulder

o       hanging cast (weight of arm in cast provide& traction across fracture site) with sling immobilization x 7-10 days, then Sarmiento functional brace

·                 operative

o       indications: open fracture, neurovascular injury, unacceptable fracture alignment, polytrauma. segmental fracture. pathological fracture, "floating elbow" (simultaneous unstable humeral and furearm fractures), intra-articular

o       procedure: compression plating (most common), Intramedullary rod Insertion, external fixation

Specific Complications (see General Fracture Complications)

·                 radial nerve Injury: expect spontaneous recovery in 3-4 months, otherwise send for electromyography (BMG)

·                 decreased ROM

·                 compartment syndrome