Fractures of the humerus in diaphysial part. Flashcards
what are the muscles associated with the humeral shaft
insertion :
pectorals major
deltoid - abducts - axillary
coracobrachiales adducts the humerus
musculocutaneous
origin :
brachialis - flexes the elbow musculocutaneous
brachioradiales -radial nerve superior to lateral epicondyle flexes elbow
what is the classification of dipahyseal fractures ?
fracture location - proximal , middle or distal third
OTA classification
simple - spiral
oblique
traverse
wedge
spiral
bending
fragmented
complex
spiral complex
segmented
irregular
which type of fracture has the highest incidence of radial nerve injury ?
those occurring in the distal third(where the radial nerve comes anteriorly)
for example the holstein lewis fracture (spiral fracture) and
(2)
what are the term valgus and varus?
when there is bowing of the bone in relation to the distal part of long bones
in valgus it is more lateral
in varus it is more medial
in physical examination of the dipahyseal fractures what is the clinical presentation ?
radial nerve malfunction
when examining the overall limb alignment there will be shortening of the humerus and more likely to be in varus
what is the function of the radial nerve and how will we see if it is damaged ?
they innervate the extensors the would not be able to extend the wrist or forearm and their wrist would flap down - they cant extend the wrist as if stopping traffic
weakness of supination
loss of sensation in posterior forearm
radial half of the dorsal surface of hand
what are the non operative indication for humeral shaft fracture?
most of the HUMERAL SHAFT FRACTURE goes through nonoperative means and only if it meets the criteria of :
less than 20 degree anterior angulation
less than 30 degree varus /valgus angulation
less than 3 cm shortening
= 90 percent union rates (EXCEPT FOR PROXIMAL THIRD OR SPIRAL FRACTURES)
what are the absolute contraindication for the non operative method ?
severe soft tissue injury or bone loss
vascular injury requiring repair
brachial plexus injury
radial nerve palsy is NOT a contraindication
what are the operative indications for humeral shaft fractures ?
open fracture
vascular injury requiring repair
brachial plexus injury
with ipsilateral fracture of radial/ulna shaft or radius and ulna head fracture - floating elbow
compartment syndrome
in the OTA it is comminuted or fragmented
failure more in transverse fractures
what are the indications for intrameduallary nailing ?
pathologic fractures
segmental fractures
severe osteoporotic bone
what are the non operative techniques ?
COAPTATION SPLINT
applied till swelling resolves
adequately applied splint extend up to axilla and over the shoulder
the elbow is flexed at 90 degrees
mould to counteract deformity - valgus mould if varus
followed by functional bracing
- extends 2.5cm distal to axilla and 2.5cm proximal to the humeral condyles
what are the operative methods ?
open reduction and internal fixation with osteosynthesis compression plating (BETTER THAN RODS) absolute stability with lag screw
significant comminution - pate in bridging mode - bypasses the comminution giving it vascularity to heal
why are plate fixation preferred to rod ?
plate fixation is more stable
less reop
using rod there is more
shoulder pain and stiffness
not difference in functional shoulder outcome scores , no difference in nerve injuries
what are the complications in humeral diaphysis fractures ?
nonunion -do open reduction with plate fixation and bone graft or bone graft substitute
maluinion - more common in traverse fracture
radial nerve palsy
increased incidence distal one-third fractures
brachioradialis first to recover, extensor indicis is the last
