Fracture of the shaft humerus

MUHAMMED KOCABIYIK SMAL NEBYEV

PHYSICAL THERAPY & REHABILITATION III.CLASS V.COURSE

Introduction
3% of all fracture Treatment are made non operative and operative management Most of humeral shaft fracture can be managed nonoperatively Mechanism of injury : direct trauma and indirect trauma A careful neurovascular examination with radial nerve function

Anatomy
Shaft of humerus extends proximally from the upper border of pectoralis mayor inserstion to the supracondyler ridge distally Deltoid muscle insert onto deltoid tuberosity, locatedon the anterolateral surface of prox part Anterior border : anterior aspect of great tuberosity to coronoid fossa Medial and lateral intermuscular septa divide arm into anterior and posterior compartement. Anterior compartement ( flexor):biceps brachii,coracobrachialis, brachialis muscles Posterior compartement ( extensor ) : triceps muscle

The muscle forces that act on the humeral shaft produce characteristic fracture deformities.

Classification
There is no universally accepted classification system for humeral shaft fracture Classified on the location ( proksimal,middle,distal), direction and character ( trancverse,oblique, spiral, segmental, comminuted),associated soft tissue injury, associated neurovascular injury

Methods of treatment
Non operative : hanging arm cast, U-shape coaptation splint, a velpeau shoulder dressing, functional bracing etc

Operative treatment Indication : open fracture, associated vascular injury, floating elbow, segmental fracture, pathologic fracture, bilateral fracture , polytrauma , radial nerve dysfunction after manipulation, with unacceptable alignment,intra articular fracture extension

By plating and screw, nailing, external fixation

Surgical approach
Anterolateral Position : supine with the arm lying on arm board,abducted 60, apply torniquet Landmarks : biceps brachii muscle and flexion crease of the elbow Incision : curve longitudinal incision over lateral border of biceps Incise deep fascia inline with skin incision Retract biceps medially, to reveal brachialis and brachioradialis Incise lateral border brachialis muscle longitudinally, retract medially Anterior aspect of the bone by subperiosteal dissection

Posterior Position : lateral position with the affected side uppermost or prone with arm abducted 90, sandbag place under shoulder,forearm hang over

Landmark : acromion and fossa ollecranon Incision : longitudinal incision in midline posterior aspect arm from 8 cm below acromion

Complication Radial Nerve palsy (18%) Infection (0-6%) Non union (1-15%) Brachial artery injuries

Rehabilitation Immediate to one week : exercise ROM shoulder and elbow as pain allows Two weeks : pendulum exercise . No weight bearing Four-six weeks : light weight bearing Eight-twelve weeks : full activities