Humerus Fracture2

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    Humerus Fracture

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    Comm

    on Site

    of humerusfracture.

    O Surgical neck fracture.

    O Avulsion fracture of greater tubercle.

    O Shaft of humerus

    O Elbow(intercondylar fracture of humerus)

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    O Avulsion Fracture : An avulsion fracture is a closed fracturewhere a piece of bone is broken off by a sudden, forceful

    contraction of a muscle. This type of fracture is common inathletes and can occur when muscles are not properlystretched before activity. This fracture can also because ofan injury.

    O Impacted Fracture : An impacted fracture is similar to a

    compression fracture, yet it occurs within the same bone. Itis a closed fracture which occurs when pressure is appliedto both ends of the bone, causing it to split into twofragments that jam into each other. This type of fracture iscommon in car accidents and falls.

    O Stress Fracture : It is a common overuse injury. It is mostoften seen in athletes who run and jump on hard surfacessuch as runners, ballet dancers and basketball players.

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    O Compression fracture of the spine : It is common in

    individuals with osteoporosis. Often no identifiable injury

    causes it. This results in significant pain and disability.

    O Rib fractures : If you experience pain while breathing you

    probably have a rib fracture. In this condition you also have

    tenderness and shallow breathing.

    O Complete Fracture : in this the bone fragments separatecompletely.

    O Incomplete Fracture : in this the bone fragments are still

    partially joined.

    O Linear Fracture : in this the fracture is parallel to the bone'slong axis.

    O Transverse Fracture : in this the fracture is at a right angle to

    the bone's long axis.

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    O Oblique Fracture : in this the fracture is diagonal to a bone's

    long axis.

    O Spiral Fracture : in this at least one part of the bone has

    been twisted.

    O Comminuted Fracture : in this the fracture results in several

    fragments.

    O Compacted Fracture : in this the fracture is caused when

    bone fragments are driven into each other.

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    Types ofHumerus FractureProximal Humerus

    Fracture

    Mid-shaft HumerusFracture

    Distal HumerusFracture

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    O Proximal Humerus Fractures

    Proximal humerus fractures occur near the

    shoulder joint. The shoulder joint is a ball-and-socket joint, with the ball being the top

    of the humerus bone. Fractures of this ball

    are considered proximal humerus fractures.

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    O Mid-Shaft Humerus Fractures

    - occur away from the shoulder and elbow

    joints.-heal without surgery, but there are some

    situations that require surgical intervention.

    -These injuries are commonly associated with

    injury to one of the large nerves in the arm,called the radial nerve.

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    DistalHumerus FractureO Distal Humerus Fractures

    -uncommon injuries in adults. -

    These fractures occur near the elbow joint.-These fractures most often require surgical

    treatment unless the bones are held in

    proper position. This type of fracture is much

    more common in children, but the treatment

    is very different in this age group.

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    O Supracondylar fractures of

    humerus are very common

    injuries in children. Theseinjuries frequently result

    when the child falls on

    outstretched hand.

    O Supracondylar region inchildren is weaker in

    children as the part is

    growing.

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    Management ofHumerus Fracture

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    O There are several factors that determine whether your

    surgeon will suggest treating the fracture with or without

    surgery.

    1.The surgeon must first decide if the

    fracture can be reduced to acceptable

    alignment and held there without

    surgery.

    2.Other factors will be considered

    including your age, general health, whether

    you have osteoporosis and whether this is

    your dominant arm.

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    O General principles:

    The fracture should be immobilised as soon as possible and

    potent analgesia given. Keep the patient comfortable and

    minimise any need for movement. Open fractures, those

    associated with a shoulder dislocation or combined withfracture in the forearm are a surgical emergency and an

    immediate orthopaedic opinion is necessary.

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    TreatmentO Nonsurgical

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    O Surgical

    If the fracture cannot be held in acceptable position with a

    hanging cast or fracture brace, surgery may be suggested

    after several days or weeks of attempting non-surgical

    treatment. If the radial nerve was working during the initial

    evaluation but stops working after treatment by closed

    reduction, your surgeon may need to perform surgery to makesure that the radial nerve has not become trapped between

    the bone fragments of the fracture.

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    Surgicaltreatment of humeralshaft fracturescanbeperformed in three ways:an intramedullary

    rod(ametalrod insidethe bone),ametalplateandscrewsalongtheside ofthe bone, oranexternal fixator with metalpinsthrough theskin.The intramedullaryrod iscommonlyusedto treathumeralshaft fractures.The intramedullaryrod isalongmetalrodthat isplaced insidethe hollowshaft ofatubular bonesuch asthe humerus.Themetalrodcan be inserted into the humerusthrough asmall incision attheshoulder. In somecases,therod is insertedattheelbow.Theintramedullaryrod is inserted with theaid ofa

    special X-raymachinecalledafluoroscope.Thefluoroscopeallowsthesurgeon to seean X-rayimage ofthe bones on atelevision monitorandguidetheplacement ofthe intramedullaryrod by

    viewingthis image.

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    O Open Reduction and Internal

    Fixation (ORIF) of humeral shaft

    fractures using a metal plate and

    screws is also very common. This

    type of treatment requires a

    relatively large incision. ORIF with

    a plate and screws is usually the

    treatment of choice when the

    radial nerve must be explored,

    since an incision will need to bemade to expose the fracture

    anyway.

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    External fixation is notcommonlyused for

    humeralshaft fractures.Thistype oftreatmentmaybe necessaryfor openfractures when therisk of infection is high.Theexternal fixation deviceallowsthesurgeon to placemetalpinsthrough theskin

    and into the bone fragmentsawayfromthefracturesite.Thesemetalpinsarethenconnectedto ametal frameoutside the skin.The fracture isstabilized, butthereare noforeign materials (such asmetalplates) in the

    fracturesiteto harborthe infectious bacteria.The fracture islesslikelyto developosteomyelitis,an infection ofthe bone.