The neer classification for proximal humerus fractures is based on 4 fracture parts. Frequentes, su tout chez ladulte, leu p onostic peut ete aggave pa. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side. A, only a single xray was obtained before reduction, so additional displacement in the perpendicular plane cannot be assessed. The humerus is the long bone that runs from your shoulder to your elbow. The humerus is a relatively common site of pathological fracture. The humerus is roughly cylindrical in shape and transitions to a triangular shape distally fig. As discussed in the image above, most shoulder fractures which are nondisplaced or minimally displaced do not require surgery. Boukhatmi leila, maitreassistante en anatomie normale.
Other causes are low bone density and osteoporosis, which cause weakening of the bones. This is when the proximal humerus is broken into three pieces, and there are then two fracture lines on xray. The elbow joint is a hinge joint and consists of three components. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. In addition, contraindications vary widely based on the treatment administered. Proximal humerus fracture shoulder 7 fracture care team. The full text of this article is available in pdf format. Distal humerus fractures what i have learned principles of orif restore articular congruity maximize fixation in distal fragments at least three screws medially and laterally screws as long as possible compress supracondylar component of fracture robust plates if shaft extension 21 yo snowboarding special plates not needed for.
Gw balfour, v mooney and me ashby brace diaphyseal fractures of the humerus treated with a readymade fracture this information is current as of november 2, 2007. Jan 04, 2016 lecture 1 of 2 on distal humerus fractures. Supracondylar fractures of the humerus in children are the result of trauma to the elbow, most often a fall from height or related to sports or leisure activities. Limb swelling predating fracture, or marked post fracture swelling. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Gartlands classification of supracondylar fracture of humerus. The humerus is located in the upper arm and humerus fracture occurs due to a fall or direct trauma or may be caused by disease such as pagets disease. The annual rate of children who present with supracondylar fractures. Video lecture with narrations and live annotations from. A particular concern in managing supracondylar humerus fractures is the potential for this fracture to cause vascular compromise of the limb, which can lead to longterm loss of nerve andor muscle function.
Surgical technique global unite platform shoulder system anatomic fracture and reverse fracture depuy synthes 9 humeral preparation greater and lesser tuberosity mobilization mobilize the greater and lesser tuberosities from adhesions and attached hematoma. Proximal humerus fracture discharge care what you need to. Her xray shows a comminuted midshaft humerus fracture with angulation of the distal fragment. Dr balaji vinayaka mission kirubananda variyar medical college. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over.
Fracture that involves the epiphyseal plate or growth plate of a bone type i. Although this case does not perfectly fit into headsplitting or impaction fracture categories, the fracture clearly involves a significant portion of the articular surface. Second, the type of fracture has to be carefully considered. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact. 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. The pdf of the article you requested follows this cover page. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Proximal humerus fracture east sussex healthcare nhs. Distal humerus fractures of the elbow orthoinfo aaos. The treatment of pediatric supracondylar humerus fractures. If the fracture is type 4, operative management is recommended 4. Throwers fracture of the humerus mdedge emergency medicine.
Pdf most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated nonoperatively. In an older person who has weaker bones, however, even a minor fall may be enough to cause a fracture. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. First, it should be noted that the distance of displacement is an important factor to determine the success of nonoperative management 3. Management of proximal humeral fractures based on current. This 17yearold female was struck by a car while crossing a road. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder.
Suspect pathological fracture if any of the following features are present. There is also an impaction fracture of the glenoid. The adequacy of diagnosis and treatment for osteoporosis in. Overuse can cause stress fractures, which are very. If the broken bone punctures the skin, it is called an open or compound fracture. The deforming forces applied to each segment are determined by the position of the fracture line. A humerus fracture is a break of the humerus bone in the upper arm. The classification of bicolumn distal humerus fractures. The fracture line typically occurs distal to the surgical neck and proximal to the supracondylar ridge. Distal humerus fractures orthopaedic trauma association. Complications may include injury to an artery or nerve, and compartment syndrome. The proximal humerus is one of the bones in your shoulder joint. Bennett fracture dislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. A throwers fracture is a rare fracture pattern characterized by a spontaneous fracture of the mid to distal third of the humeral diaphysis during an attempted throwing motion.
From ring et al for very distal comminuted fractures. Image 2 shows the detail of a proximal humerus fracture comparing the routine xray and a 3d ct reconstruction. Humeral shaft fractures pediatric orthopaedic society of. The purpose of this study was to evaluate whether physicians practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. A fracture in this area can be very painful and make elbow motion difficult or impossible. This is an enhanced pdf from the journal of bone and joint surgery. The incidence of radial nerve palsies related to the humerus ranges from 2. Pdf proximal humerus fractures represent an increasing challenge for the health system due to epidemiological changes. Pdf proximal humerus fractures current treatment options. Le chirurgien a pratique une osteosynthese par clou t2 strycker. To evaluate the outcomes in patients treated for humerus distal third fractures with mipo technique and visualization of the radial nerve by an accessory approach, in those without radial palsy before surgery. Classification of humeral shaft fractures humerus fractures are divided into open or closed fractures, location proximal, middle, and distal, angulation, and degree displaced or nondisplaced. No pt for 3 weeks, unless otherwise specified by md.
Feb 03, 2020 a proximal humerus fracture is a crack or break in the top of your upper arm bone. Proximal humerus fractures, when the fracture site is near the shoulder. Most distal humerus fractures are caused by some type of highenergy eventsuch as receiving a direct blow to the elbow during a car collision. There may be a decreased ability to move the arm and the person may present holding their elbow. Pdf the specific etiology of supracondylar humerus fractures in children is not well known. Type 2 is a type 1 with comminution of lateral condyle. Laboratoire danatomie normale et des explorations morphofonctionnelles.
Precision preoperative planning is indicated for fracture reconstructions because many of the normal bony anatomical guidelines available to the surgeon have been either disrupted or distorted by the fractures. Dec 17, 2018 pdf the humerus is the largest bone of the upper extremity and defines the human brachium arm. Leave any capsule or healthy soft tissues attached to the proximal humerus. Fractures of the shaft and distal humerus on the other hand, are more common than proximal humeral fracture in the young population. Fractures commonly happen because of car accidents, falls, or sports injuries. High t fracture a transverse fracture line divides both columns proximal to the olecranon fossa ax low t fracture a. They are also classified as being transverse, oblique, spiral, or comminuted and whether or not they involve a joint.
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