Humerus fracture

CLINICAL FEATURES:

• Pain.
• Deformity.
• Bruising.
• Crepitus.
• Abnormal mobility
• Swelling.
• Any neurovascular injury:
• Nerve involvement differ with the type of fracture.
• Anterior interosseous nerve is mostly affected during posterolateral displacement of the distal fragment
• Radial nerve is mostly affected with posteromedial displacement
• Ulnar nerve is involved in flexion type of supracondylar fracture
• Fracture of surgical neck of humerus leads to loss of abduction movement of the corresponding shoulder joint due to injury of Axillary nerve
• Tingling sensation and numbness in the little finger with history of fracture in the elbow region 4 years back is suggestive of Lateral condyle fracture humerus

 INVESTIGATION:

• Skin integrity .
• Examine the shoulder and elbow joints and the forearm, hand, and clavicle for associated trauma.
• Check the function of the median, ulnar, and, particularly, the radial nerves.
• Assess for the presence of the radial pulse.
• Radiographs
• CT scan
• MRI scan
• Nerve conduction studies
• AP and lateral views of the humerus,including the joints below and above the injury.
• Computed Tomographic (CT) scans of associated intra-articular injuries proximally or distally.
• MRI for pathological #

 TREATMENT:

NON OPERATIVE:

• Conservative Treatment
• >90% of humeral shaft fractures heal with nonsurgical management
• Most treatment begins with application of a coaptation splint or a hanging arm cast followed by placement of a fracture brace
• Periosteum is responsible for producing the majority of the new bone that will reunite the two fragments

Splinting:

• Fractures are splinted with a hangingsplint, which is from the axilla, under the elbow, postioned to the top of the shoulder .
• The U splint.
• The splinted extremity is supported by a Triangular arm sling.
• Immobilization by fracture bracing is continued for at least 2 months or until clinical and radiographic evidence of fracture healing is observed.

 OPERATIVE 

METHODS OF SURGICAL MANAGEMENT

• Plating
• Nailing
• External fixation

ANTERIOR APPROACH

• Incision
• Proximal land mark – coracoid process
• Distal land mark- anterior to lateral supracondylar ridge

 ANTERO LATERAL APPROACH

• Proximally, the plane lies between the deltoid laterally (axillary nerve) and the pectoralis major  medially(medial and lateral pectoral nerves).
• Distally, the plane lies between the medial fibers of the brachialis (musculocutaneous nerve) medially and the lateral fibers of the brachialis (radial nerve) laterally

POSTERIOR APPROACH

• Position of the patient for the approach to the upper arm in either the (A) lateral or (B) prone position
• Incision
• Tip of olecranon distally to postero lateral corner of acromion proximally
• Incise the deep fascia of the arm in line with the skin incision.
• Identify the gap between the lateral and long heads of the triceps muscle

COMPLICATIONS:

• Injury to the radial nerve.
• Nonunion rates are higher when fractures are treated with intramedullary nailing.
• Malunion.
• Shoulder pain -when fractures are treated with nails and with plates .
• Elbow or shoulder stiffness.
• “Cubitus-valgus” deformity is complication of # Lateral condyle of humerus
•  Varus
•  Gunstock deformity is due to Supracondylar fracture of humerus