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DISCUSSION

DEFENITION

Fracture a break in the structural


continuity of bone, cartilage, joint and
growth plate

Nalyagam S. Principles of Fractures. In: Solomon L. Apleys System of Orthopaedics and Fractures Ninth edition. 2010

CLASIFICATION OF FRACTURE
If overlying skin remains intact closed

fracture
If skin not intact Open facture
CLOSED FRACTURED
OPEN FRACTURED

Nalyagam S. Principles of Fractures. In: Solomon L. Apleys System of Orthopaedics and Fractures Ninth edition. 2010

EPIDEMIOLOGY
A common injury,
representing3% to
5% of all
fractures.

Incidence is 14.5
per 100,000 per
year.

Sixty percent
involve middle
third of the
diaphysis, 30%
involve
proximal third of
diaphysis, and
I0% involve distal
third of diaphysis.

Bimodal age
distribution with a
peak in the third
decade is seen in
males and peak in
the seventh
decade is seen in
females.

ANATOMY

Thompson, John C. Thigh/Hip: Netter's Concise Orthopaedic Anatomy. 2th Edition..Philadelphia: Saunders Elsevier. 2010.p.
250-3, 266-8.

ANTERIOR COMPARTEMENT

Thompson, John C. Thigh/Hip: Netter's Concise Orthopaedic Anatomy. 2th Edition..Philadelphia: Saunders Elsevier. 2010.p.
250-3, 266-8.

POSTERIOR
COMPARTEMENT

Thompson, John C. Thigh/Hip: Netter's Concise Orthopaedic Anatomy. 2th Edition..Philadelphia: Saunders Elsevier. 2010.p.
250-3, 266-8.

MECHANISM OF INJURY
DIRECT INJURY
Direct trauma to the arm from a blow or motor vehicle
accident results in a transverse or comminuted fracture.
INDIRECT INJURY
A fall on an outstretched arm results in spiral or oblique
fractures, especially in the elderly. Throwing injuries with
extreme muscular contraction and arm wrestling have also
been reported to cause humeral shaft fractures.
FRACTURE PATTERN DEPENDS ON THE TYPE
OF FORCE
Compressive: proximal or distal humerus fractures
Bending: transverse fractures of the humeral shaft
Torsional: spiral fractures of the humeral shaft
Torsional and bending: oblique fracture, often accompanied
by a butterfly fragment

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

AO/ASIF CLASSIFICATION

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

HOW TO DIAGNOSES
HISTORY
TAKING

CLOSED
FRACTURE
1/3 MIDDLE
RIGHT
deformity (+), hematom
HUMERUS
(+), swelling
(+),

Pain at the right


upper limb
History o trauma

CLINICAL
EXAMINATION

Tenderness (+)
Pain of movement
NVD is normaly

IMAGING
STUDIES

Transverse
fracture 1/3
middle os
humerus

Apley s System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

Restore function

Rehabilitatio
n
Recognize

Fracture site, types of


fracture

Reduction

For adequate
apposition and normal
alignment of bone

Retain

Maintain the reduction

MANAGEME
NT

Initial Treatment
Apply arm sling
Pain alleviation
To minimize soft tissue injury

TREATMENT
OPERATIV
E
NON
OPERATIV
E
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

NON OPERATIVE TREATMENT


METHOD OF NON OPERATIVE TREATMENT

HANGING CAST

COAPTATION
SPLINT

THORACOBRACIA
L
IMMOBILIZATION

SHOULDER SPICA
CAST

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

NON OPERATIVE TREATMENT

Thoracobrachial Immobilization
(Vlapeu Dressing)

Shoulder Spica Splint

OPERATIVE TREATMENT
INDICATION :
Multiple trauma

Inadequate closed
reduction or
unacceptable malunion

Pathologic fracture

Associated vascular
injury

Floating elbow

Segmental fracture

Intra-articular fracture
extension

Bilateral humeral
fractures

Open fracture

Neurologic loss following


penetrating trauma

Brachial plexus injury

Radial nerve palsy after


fracture manipulation
(controversial)

Unfavorable body
habitus such as morbid
obesity or pendulous
breasts (relative
indication)

Chronic shoulder or
elbow stiffness as it
results in increased
motion through the
fracture and increases
the risk on nonunion
(relative indication)

Nonunion

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

OPERATIVE TREATMENT
METHOD OF OPERATIVE TREATMENT

PLATING

NAILING

EXTERNA
L
FIXATION
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.

COMPLICATION

Non
union

Implant
failure

Infectio
n

Radial
nerve
injury

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 46475.