Fracture Humerus

Fracture Humerus

Proximal end fracture

1. The head
2. Greater tuberosity
3. Lesser tuberosity
4. Surgical neck

Greater Tuberosity

• Provides attachment to:
• Supraspinatus, infraspinatus, Teres Minor

Greater Tuberosity

• Management:
  • Minimally/non displaced:
    • conservative Sling
  • Severely displaced: internal fixation
    • By screws / tension band / plate
    • To regain function of rotator cuff

Surgical Neck- Problem

• If osteoporotic bone
• Difficult fixation
• Possible associated injury to Axillary nerve
  • Motor: Deltoid
  • Sensory: upper lateral arm

Humeral Shaft Fracture

• Possible associated injury to The Radial nerve (why?)(signs?)

Humeral Shaft Fracture- Management

• Conservative: U-shape slab) / splint / orthosis
  • Gravity maintains reduction

Humeral Shaft Fracture

• Management:
• Operative: (plate or IMN)
• Indications:
  • Sever displaced Unreduced,
  • Bilateral,
  • multiple injuries
  • floating elbow,
  • Needs to use crutches
  • Patients’ preference (active, athlete)

Fracture Distal Humerus

• Treated by open anatomical reduction and internal fixation by plates and screws
• Early mobilization to prevent elbow stiffness

---

Fracture Radial Head / Neck

• Clinical Presentation:
  • Pain at elbow
  • Localized swelling
  • Inability to supinate/pronate. Might still be able to flex/extend elbow slightly

Possible Associated Injury

• Examine the wrist:
  • For disruption of the distal radio-ulnar joint
• The posterior interosseous nerve
  • damaged by the initial injury or by the surgery performed to treat the fracture
  • Therefore, document functional status preoperatively

X-ray

• A visible posterior fat pad on the lateral view of the elbow is a sign of occult intra-articular trauma

Fracture head / neck of radius

• Management In Minimal head displacement:
  • Conservative treatment
  • Cast above elbow & sling
  • Early motion to minimize elbow stiffness

Fracture head / neck of radius

• Management if the fracture involves more than 33% of the articular surface or is sever displaced
  • Surgical treatment:
    • ORIF if possible
    • Radial head Replacement if comminuted /inoperable