In elderly patients, diminished bone mineral quality and increased traumaassociated joint destruction may make stable joint reconstruction even more problematic. Its especially strong and is capped with the ball of the ballandsocket shoulder joint. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. To prevent extensive diaphyseal stress, the medial and dorsolateral plates may not have the same length. Proximal humerus fractures are common, but associated injury of the axillary artery is uncommon. Proximal humerus fracture east sussex healthcare nhs. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Treatment decision of displaced proximal humeral fractures is based on bone quality, fracture pattern, degree of displacement and patient profile.
One of the nerves that travels from the neck to the hand, the radial nerve, spirals around the humeral shaft lying very close to the bone about. These fractures tend to occur in older patients who are osteoporotic. The majority of published blunt traumatic axillary artery injuries. There may be a decreased ability to move the arm and the person may present holding their elbow. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results.
Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Functional bracing of fractures of the shaft of the humerus. Treatment of the humeral shaft fractures minimally. A humerus fracture is a break of the humerus bone in the upper arm.
Effect of progressive controlled weight bearing of upper. Traditionally, humeral shaft fractures have been described according to the following features. Midshaft humerus fracture east sussex healthcare nhs trust. Humeral shaft fractures musculoskeletal medicine for. The journal of orthopaedic research, a publication of the orthopaedic research society ors, is the forum for the rapid publication of high. Proximal humerus fracture you have sustained a fracture to your shoulder. The anatomic characteristics of the proximal humerus largely explain the various fracture presentations, complications, and outcomes. Suspect child abuse in a child presenting with humerus and other fractures, especially if younger than 18 months of age. Humerus fx orif protocol proximal, midshaft, or distal. The humerus is the long, tubular bone that makes up the upper arm. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. The humerus is the bone in your upper arm, between your shoulder and elbow. Mechanism of injury there are several unique features of the humerus that.
Distal fractures including intraarticular fractures will be included in chapter 11. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Proximal humeral fractures figure 1 are common, particularly in the elderly. Proximal humerus, threepart fracture, fourpart fracture, surgical treatment, orif. Location proximal, middle, or distal type of fracture line transverse, oblique, spiral, comminuted, or segmental opened or closed status this article focuses on midshaft humerus fractures. One of the most important features of humeral fractures in children is their ability to remodel and heal with minimal to no deformity despite displacement and angulation. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age.
Shoulder arthroplasty for acute proximal humerus fracture em. The full text of this article is available in pdf format. Fractured clavicle fractured humerus emergency department what is a fracture. Fracture distal humerus in adults authorstream presentation.
This normally takes between 912 weeks to unite heal. Humerus fractures are common injuries most often caused by falls and motor vehicle accidents. The prediction of cyclic proximal humerus fracture fixation failure by. Nondisplaced means less than 1cm of displacement and less than 45. A mid shaft humerus fracture is a type of broken arm. Effect of progressive controlled weight bearing of upper extremity following proximal humeral fracture.
Most of the times these heal without requiring surgery, however, some severe cases may require surgical intervention. The shoulder is a ball and socket joint and you have fractured just below the ball part. The humeral shaft is the middle portion of the bone with the shoulder joint at the top end and the elbow joint at the bottom. Fractures involving the proximal humeral physis are categorized by the salter harris classification system and fractures of the metaphysis are described by the amount of angulation and displacement at the fracture site. The proximal twothirds of the bone are curved and the distal shaft extends into the condyle. In more elderly people, humerus fracture due to a fall is generally proximal, sub or infracapital. Clavicle fractures are most common in children and young adults, typically occurring in per sons younger than 25 years. Occasionally it may be caused by falling onto an outstretched hand when the arm is abducted out to the side. Most of the patients underwent surgery within 24 hours after injury. Pdf midshaft humeral fracture following a proximal. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which influence elbow function negatively.
Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Shoulder, fracture, humerus, prosthesis, hemiarthroplasty, reverse prosthesis. Proximal humerus fractures include fractures involving the proximal humeral physis and metaphysis. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Fracturing the bone of your upper armmedically known as a humerus fracturecan be a painful and frightening experience, especially because the most common cause of this type of fracture is a bad fall. In this case, a patient who was progressing well following a proximal humeral fracture sustained a separate displaced fracture of the midshaft of the humerus, not associated with therapy. Midshaft humerus fractures are usually the result of. Elastic stable intramedullary nailing of humerus fractures in children. Proximal humeral fractures while uncommon, and typically seen in an elderly population, often occur following a fall from a standing height. Humerus fractures are divided into three types of injury. Fractures of the proximal humerus are common, accounting for 5% of all fractures. Sean griffin weeks 14 wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks. The humerus fracture needs to be acceptably reduced in a relatively normal. Proximal humerus fractures phf are uncommon but characteristic posttraumatic lesions in children and adolescents.
It also includes the hinge of the elbow joint on the bottom. Proximal humerus fractures in children and adolescents. Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction. In younger patients, highenergy trauma is the cause of injury. The unique and complex shape of the humerus makes fracture repair challenging. Lcp distal humerus plates preparation 5 determine the length of the plates choose plate lengths that offer sufficient fixation proximal to the fracture lines. Look for radial nerve injury in patients with middle rd to distal rd shaft fracture. Surgeon quote the periloc proximal humerus plate is particularly useful in proximal humerus fractures with shaft extension due to its unique contour such that it curves anterior as it goes distal. Nonoperative proximal humeral fracture rehabilitation protocol.
Surgical treatment of three and fourpart proximal humeral fractures. Mechanism of injury direct trauma is the most common especially mva indirect trauma such as fall on an outstretched hand fracture pattern depends on stress applied compressive proximal or distal humerus bending transverse fracture of the shaft torsional spiral fracture of the shaft torsion and bending oblique fracture usually associated. The lesser tuberosity of the humerus is located on the anterior surface of the humerus and provides the attachment for the subscapularis muscle. Elderly patients with weaker bone can break their arm with relatively low levels of force e. The aoasif fracture classification helps in guiding treatment. Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Closed reduction of the fracture was achieved in 23 patients. A fracture is a break through all or part of a bone. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention consider risk for compartment syndrome if any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. In patient 2, the father of a 3monthold girl sought to explain how he broke his daughters left humerus.
Proximal humerus fractures pediatric orthopaedic society. The pdf of the article you requested follows this cover page. Fracture line classifications transverse oblique spiral segmentwedge 21. Historically, the treatment of choice has been functional bracing. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. He is neurovascularly intact in his left arm and leg. Management of these fractures has been discussed in.
Various common injuries in the shoulder, humerus, and elbow are investigated in this section. In the shoulder, a fracture is usually in the collar bone clavicle, or in the upper arm bone humerus. Along with proximal femoral, distal radial, and vertebralbody. Humeral shaft fractures humeral shaft fractures account for 3% to 5% of all skeletal fractures. Proximal humeral fracture is the second most common fracture of upper limb. Radiographs showed an oblique displaced fracture extending through the midshaft of the humerus. We will explain how a midshaft humerus fracture is diagnosed, different ways to treat a broken arm, and what are the outcomes after a broken arm, and the risk of radial nerve injury. Midshaft humerus fracture treatment verywell health. A patients guide to adult humerus shaft fractures anatomy. There is a predominance of women due to postclimactic demineralization of the skeleton 43. Humerus fractures are divided into open or closed fractures, location proximal, middle, and distal, angulation, and degree displaced or nondisplaced.
The craniolateral aspect of the humerus is widely accepted as the tension side of the bone and is suitable for placement of a bone plate. Capitellar and trochlear fractures type i these are isolated capitellar fractures involving a large portion of cancellous bone. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Study of incidence and treatment of radial nerve palsy in. Fractures joint replacement sports medicine humerus fx orif protocol proximal, midshaft, or distal orif dr. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions. In patient 1, parents of a 5monthold boy fortuitously videotaped their infants unintentional right humeral spiral fracture injury as it occurred in their home. Midshaft humerus fracture you have sustained a fracture to the middle portion of your humerus upper arm bone. We discuss a midshaft humerus fracture using simple language and useful pictures to help everyone understand this topic. However, good surgical outcomes can be achieved with proper patient selection.
No classification scheme for humeral shaft fractures. Highenergy trauma, fracture location at the middledistal humerus, and simple transverse fracture or comminuted fracture with butterfly fragment seems to be risk factors for radial nerve transection. Check for ecrlecrb, edc, ecu, eip, and epl functions. Axillary artery injury associated with proximal humerus fracture. A midshaft humerus fracture is a type of broken arm. Fractures of the distal humerus are difficult to treat. Management of displaced proximal humeral fractures. Adult humerus shaft fractures midwest bone and joint. This fracture generally is located in the shaft between the shoulder and elbow joint. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis.
Aetiology in principle, the mechanism of injury may be direct or indirect. Its superficial location, its thin midshaft, and the forces trans. Holsteinlewis fracture a spiral fracture of the distal onethird of the humeral shaft 22% incidence associated with neuropraxia of the radial nerve 23. A proximal humerus fracture is a break of the upper part of the bone of the arm. Proximal humeral fractures were discussed in chapter 9. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. Most humeral shaft fractures unite if left alone in the same room. Heal a humerus fracture without surgery the jackson. This type of fracture occurs close to the shoulder joint midshaft humerus fractures. Randomised control study seeta singh, keerthi rao, chandra iyer, subhash khatri pravara institute of medical sciences of college of physiotherapy abstract background. This keeps me from having to strip the soft tissue from the lateral humerus. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Clavicle fractures american academy of family physicians.
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