Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. As a matter of fact, most humeral shaft fractures, which occur in. If there is any concern as to the nature of the fracture, orthopaedic referral at presentation should be sought. Modified combined approach for distal humerus shaft. The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. Humeral shaft fracture stabilization with elastic nails. There has been no report on the fracture pattern, complications and surgical outcomes regarding ipsilateral humeral neck and shaft fracture in.
The results of this treatment were excellent, in comparison to what little data are available describing treatment of open humeral shaft fractures with either intermedullary nails or with external fixation. The pdf of the article you requested follows this cover page. Humeral shaft fractures can occur in severe accidents. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Despite comminution of the greater tuberosity fracture, the axial height from its donor site on the shaft can generally be estimated. Although they occur in all age groups, a bimodal distribution is noted. No classification scheme for humeral shaft fractures. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to.
For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. The upper portion of the bicipital groove often remains attached to the fractured lesser tuberosity. Get the definitive, two volume guide on fracture treatment, written by the worlds top orthopaedic surgeons. Most humeral shaft fractures unite if left alone in the same room. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a longer hospitalization time 9.
Fractures of the distal humerus anatomical terms of. Most distal humerus fractures are caused by some type of highenergy eventsuch as receiving a direct blow to the elbow during a car collision. Fracture mechanisms and injuries causing traumatic femoral shaft fractures. As a matter of fact, most humeral shaft fractures, which occur in young children are the result of child abuse or birth trauma. Humeral shaft fractures are very infrequent in children only 25% of all pediatric fractures 1, 2. Humeral shaft fractures are frequent, accounting for 1% to 3% of all fractures in adults. Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. Fractures of the distal humerus free download as powerpoint presentation. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. An electronic literature search was conducted using medline database, restricted to english language. Jul 15, 2012 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.
This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Fracture union in closed interlocking nail in humeral shaft fractures. Physiologically induced motion at the fracture site favors healing of the fracture. F ractures of the humeral shaft account for approximately 3% of all fractures. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. A humeral shaft fracture complicated with anterior shoulder. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Eric gordon definition humeral shaft fractures comprise approximately 2.
A similar postoperative rehabilitation program was applied for all subjects for the next 12 months. Article information, pdf download for operative versus nonoperative. A midshaft humerus fracture occurs in the middle of the humerus bone and usually does not involve the shoulder or elbow joints. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Aug 07, 20 nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Due to their etiology, they are predominantly seen in children aged less than 3 years or more than 12 years. Humeral nonunion is defined as a fracture with no evidence of healing 24 weeks after injury.
Nerve injury particularly of radial nerve, must be ruled out before any management is. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. Functional bracing of fractures of the shaft of the humerus. Surgical results of open reduction and plating of humeral shaft fractures h t hee,mbbs, frcs edin, frcs glas, b y low,fams, frcs edin, frcs glas, h f see,fams, mbbs, frcs glas abstract thirtyfive patients who sustained humeral shaft fractures were treated by open reduction internal fixation using ao techniques between 1992 and. Humeral shaft fractures should be referred to fracture clinic at 1 week. Fractures of the humeral shaft powerpoint presentation free to download id. If youve been hurt, call me for free, friendly advice. Surgical results of open reduction and plating of humeral. Sixty humeral shaft fracture patients with a minimum age of 18 years were randomly assigned into two groups. May cause palsy seconary to tethering of radial nerve in lateral intermuscular septum or entrapment in fracture site.
In an older person who has weaker bones, however, even a minor fall may be enough to cause a fracture. Humeral shaft fracture radiology reference article. Fracture after lowenergy trauma must prompt further investigation, focusing on the possibility of malignancy or severe osteoporosis. Humeral shaft fractures musculoskeletal medicine for.
These recurring fracture patterns can often serve as an in situ template during an anatomical. Treatment of the humeral shaft fractures minimally invasive. Scribd is the worlds largest social reading and publishing site. Alright, now in this part of the article, you will be able to access the free pdf download of handbook of fractures 5th edition pdf using our direct links mentioned at the end of this article. A guide to assessment and treatment pdf free download. Among patients with femur shaft fracture in the acute critical care center in a rural area of. Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. Humeral shaft fractures were identified by the international classification. In evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important.
Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Nov 07, 2019 in evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important. Humeral shaft fractures accounts for 35% of all fractures and are associated with great risk of radial nerve injury which is situated in spiral groove in posterior aspect of humerus. Ziran introduction the humerus, like the femur, is a single large tubular bone protected by a large circumferential muscle envelope. The shortening of the humeral shaft that has been observed in a few instances is also of no clinical significance. Simple humeral shaft fractures aoota classification types a and b were reduced by open reduction or closed reduction and fixed with a narrow 4. Nov 16, 2018 traditionally, humeral shaft fractures have been described according to the following features. Rockwood and greens fractures in adults 8th edition 2. Handbook of fractures 5th edition pdf free download. The humeral shaft supplies the attachment for a number of powerful muscles. Minimally invasive plating osteosynthesis for middistal.
Rockwood and greens fractures in adults 8th edition 2 volume set pdf free download direct link need the goto reference on adult bone and joint injuries. Ao principles of fracture management pdf free download. Management of these fractures has been discussed in. This represents a growing public health concern in a climate of cost containment. Surgical treatment is reserved for specific conditions. 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. 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. These fractures can be caused by car accidents, sports injuries. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. A divergence of opinion exists in the literature between the values of imn and minimally invasive plating.
The few degrees of angulation at the fracture site are difficult to recognize and therefore are not cosmetically unsightly. Timing of femoral shaft fracture fixation affects length of hospital stay in patients with multiple injuries. 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. Keywords humerus, surgery, fracture fixation, brace, fractures ununited, treatment outcome. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Minor angulatory deformities which frequently occur do not constitute a functional deficit. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and therefore, can be managed nonoperatively. Fractured clavicle fractured humerus emergency department what is a fracture. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. A divergence of opinion exists in the literature between the values of imn and minimally invasive plating osteosynthesis for the treatment.
The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Surgical factors contributing to nonunion in femoral shaft fracture. There has been no report on the fracture pattern, complications and surgical outcomes regarding ipsilateral humeral neck and shaft fracture in the literature, nor suggested fracture mechanism. Outcome of nonoperative vs operative treatment of humeral. The adobe flash plugin is needed to view this content. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Femoral shaft fractures orthopaedic trauma association. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Delayed internal fixation of femoral shaft fracture reduces. Pyati 10 fractures and dislocations of the elbow 1 edward r. Presence of wound, which denotes presence of open fracture, must prompt urgent attention. A humeral shaft fracture complicated with anterior.
Traditionally, humeral shaft fractures have been described according to the following features. A humerus fracture is a break of the humerus bone in the upper arm. Treatment of the humeral shaft fractures minimally. Murphyplease register your product online registrationao principles of fracture. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america.
Traumatic posterior dislocation of hip with ipsilateral fracture of. A fracture in this area can be very painful and make elbow motion difficult or impossible. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Distal humerus fractures of the elbow orthoinfo aaos. Humerus fractures are divided into three types of injury. Nonunion of humeral shaft fractures following flexible. A fracture is a break through all or part of a bone. Review article management of humeral shaft fractures.
Jul 22, 2016 humeral shaft fracture stabilization with elastic nails nathan w. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Fracture of the humeral shaft is commonly due to fall and highenergy impact injury. The incidence of humeral shaft fractures has been increasing over time. Anterolateral and lateral bimodal approach tong joo lee, md, dae gyu kwon, md, suk in na, md, seung do cha, md department of orthopedic surgery, inha university hospital, incheon, department of orthopedic surgery, myongji hospital, kwandong universitiy college of medicine, goyang, korea. May cause palsy seconary to tethering of radial nerve in. In the shoulder, a fracture is usually in the collar bone clavicle, or in the upper arm bone humerus. There always exists a dilemma regarding the treatment. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Humeral shaft fractures pediatric orthopaedic society of. Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. This is the current gold standard method for conservative treatment of humeral shaft fractures. Secondary radial nerve palsy was reported in 3 cases, 1 of which had reexploration via the posterior approach.
In a recent analysis comparing different treatment options in femoral shaft fractures, it could be clearly stated. Tardy ulnar nerve palsy after fracture nonunion medial epicondyle of humerus an unusual case. Fractures of the humeral shaft a free powerpoint ppt presentation displayed as a flash slide show on id. Interlocking intramedullary nailing is a widely accepted treatment for the patients with femoral shaft fracture, with the union rate reported from. 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. Minimally displaced fractures can be handled by experienced gps after appropriate handover. Fractures of the humerus are common injuries and account for 2% to 3% of all fractures seen in clinical practice. However, good surgical outcomes can be achieved with proper patient selection. This fracture occurred over the distal third of the shaft of the humerus.
Backgroundhumeral shaft fractures are common but debate still occurs as to whether. Imn1,2 and minimally invasive plating osteosynthesis,3 which are both types of biological fixation, are safe and effective options for treating middistal third humeral shaft fractures. Operative versus nonoperative treatment of humeral shaft fractures. Ipsilateral fracture of the shaft of femur and dislocation of the hip are very rare injuries. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Handbook of fractures pdf latest edition free download ebook. Humeral shaft fracture stabilization with elastic nails nathan w. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Nov 23, 2009 anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. Humerus fracture differential diagnoses medscape reference. Epidemiology of a femur shaft fracture in an acute critical care. Mar 02, 2017 a mid shaft humerus fracture occurs in the middle of the humerus bone and usually does not involve the shoulder or elbow joints. Humeral shaft fracture treatment in the elite throwing.
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