A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Trochin en avant ou sinsere le sous scapulairetrochiter en dehors sur lequel sinsere le sus et le sous epineux. The best way to manage your fracture is to let your arm hang in the collar and cuff provided. 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. My questions and concerns have been discussed and answered to my satisfaction. Pdf treatment of distal humerus fractures with extra. 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. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and therefore, can be managed nonoperatively. She was taken to an outside hospital and placed in a splint for initial management. Pdf fractures of the humerus in the neonatal period. Spiral fractures of the humerus in toddler age and younger are strongly linked. Prognosis often is not satisfactory if pain is continuous mostly with proximal and distal humerus fracture.
Age and severityadjusted treatment of proximal humerus fractures. In some cases, the broken proximal humerus must be surgically repaired or replaced. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Coronal plane partial articular fractures of the distal humerus. Aug 20, 20 the anterolateral approach is widely used for proximal and midshaft humerus fracture as it is safe, without the need for dissection of the radial nerve. Proximal humerus fracture discharge care what you need. A fracture in this area can be very painful and make elbow motion difficult or impossible. However, good surgical outcomes can be achieved with proper patient selection. Jennings, the practice of large animal surgery vol 2. Midshaft humeral fractures should be followed up in fracture clinic at 1 week. Sep 19, 2014 the humerus is a relatively common site of pathological fracture. We treat this injury by putting your arm in a sling, or shoulder immobiliser, which keeps it at a right angle.
Fracture of the top end of the upper arm bone proximal humerus is a common injury in older people. This would be considered a onepart fracture, as although both a greater tuberosity and surgical neck of humerus fracture are present neither are significantly. Proximal humerus fractures fractures of the ball of the humerus are relatively common particularly in those affected by osteoporosis. Provide sickkids parent information sheet proximal humerus fracture pdf. Know the cuases, symptoms, treatment, prognosis, recovery period and complications of closed. Bimodal anterolateral and lateral approach for distal humerus shaft fracture clinics in orthopedic surgery vol. The humerus fracture needs to be acceptably reduced in a relatively normal position in order to be treated nonoperatively. There may be a decreased ability to move the arm and the person may present holding their elbow.
Listing a study does not mean it has been evaluated by the u. Bhatti, radial nerve paralysis associated with fractures of the humerus clin orthop 172. Closed reduction and internal fixation of completely displaced and rotated lateral condyle fractures of the humerus in children kwang soon song, md, phd, yong woon shin, md, phd, chang wug oh, md, phd, ki choer bae, md, and chul hyun cho, md, phd objective. The craniolateral aspect of the humerus is widely accepted as the tension side of the bone and is suitable for placement of a bone plate. The humerus is the least commonly fractured long bone in the cat and dog. The ao classification of proximal humeral fractures, along with the neer classification, is one of the most frequently used systems for classifying proximal humeral fractures the ao classification divides proximal humeral fractures into three groups, a, b and c, each with subgroups, and places more emphasis on the blood supply to the articular surface 1,2. Functional bracing of fractures of the shaft of the humerus.
Review article management of humeral shaft fractures. Proximal humerus fractures were treated conservatively in 41% and surgically. The average age of people who sustain a proximal humerus fracture is 6366 years. If a fracture or fracture repair is stable, then therapy should be started early. Fracture usually follows a fall on the outstretched arm a fall on the hand may twist the humerus, causing a spiral fracture a fall on the elbow with the arm abducted exerts a bending force, resulting in an oblique or transverse fracture a direct blow to the arm causes a. Nov 07, 2019 in evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important. C, type iii brobergmorrey variant, comminutedcompression fracture of the capitellum. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Modified combined approach for distal humerus shaft.
Patient often suffers with mild to moderate pain following healing of the proximal fracture. Your pain does not get better or gets worse, even after you rest and take medicine. Slatter, textbook of small animal surgery 1993 wb saunders philadelphia 16611662 24. Fractures of the extremities are the most common skeletal injuries occurring in abused children. A break, or fracture, in the surgical neck of the humerus is quite common, especially among older women. The incidence is thought to be between 12 and 30 per 100,000 per year. A previously unrecognised accidental mechanism was described in 1996 whereby a 5monthold infant was rolled by a 3yearold sibling from a prone to a supine position. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Bony healing occurs usually within 6 to 8 weeks in adults 2. Anatomy proximally, the humerus is roughly cylindrical in cross section, tapering to a triangular shape distally. All supracondylar humerus fractures treated at childrens hospital and health center, san diego chsd over. Fractures of the shaft of the humerus account for 1% to 3% of all fractures and approximately 20% of all fractures involving the bone,4 but little is known about their epidemiology. Proximal means it is the end of the bone that is closest to the body.
Surgery typically involves fixing of the fracture with plates and screws or rods inside the bone. A ct scan was also performed at the outside hospital. This bone may break fracture during sports or a fall. It extends from your shoulder to your elbow, and it is the largest bone in your arm.
Most distal humerus fractures are caused by some type of highenergy eventsuch as receiving a direct blow to the elbow during a car collision. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Activities that may result in reinjuring the shoulder should be avoided for. Home rehabilitation exercises for a broken upper humerus. A proximal humerus fracture is a break of the upper part of the bone of the arm. Fracture of the humerus advice sheet hull university. In case of closed humeral fracture, the humerus may get cracked or might get broken but is not exposed. It is the most common fracture of the humerus, as well as the most common fracture at the shoulder girdle. Proximal humerus fractures are the seventh most common fracture in frequency and correspond to approximately 80% of all humeral fractures1. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Current concepts in management abstract partial articular fractures of the distal humerus commonly involve the capitellum and may extend medially to involve the trochlea. The recovery period for most of the closed humeral fractures is usually between six to eight weeks.
The pdf of the article you requested follows this cover page. Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position displaced. The unique and complex shape of the humerus makes fracture repair challenging. The full text of this article is available in pdf format. The treatment of closed humeral fractures can be both surgical as well as nonsurgical. Surgical treatment for a proximal humerus fracture. Jul 15, 2012 mechanism of injury direct trauma is the most common especially mva indirect trauma such as fall on an outstretched hand fracture pattern depends on stress applied compressive proximal or distal humerus bending transverse fracture of the shaft torsional spiral fracture of the shaft torsion and bending oblique fracture usually associated. Splint the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and.
The socalled aeroplane splint has been found of value in the treatment of certain fractures involving the humerus near the shoulder, such as unimpacted fracture of the anatomic and surgical neck of the humerus, fracture dislocation at the anatomic or surgical neck of the humerus, and fracture of the greater tuberosity of the humerus. Fractured humerus i was able to ask questions and raise concerns with the doctor about my condition, the proposed procedure and its risks, and my treatment options. To determine the usefulness of closed reduction and. Pdf fractures of the humerus in neonates can pose a diagnostic challenge, especially when the fracture occurs in the proximal or distal epiphysis. The most useful rehabilitation protocol is the threephase system. Shoulder, humerus head fracture, sports injury, return to sports after fracture. To regain maximum function after this injury, its important to follow the specific humerus fracture rehabilitation exercises prescribed by your physical therapist. Suspect pathological fracture if any of the following features are present.
There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. D, type iv12 extends medially to include most of the trochlea. Fractures of the shaft of the humerus semantic scholar. Depending on the location and severity of the fracture, some bones may heal without surgery. This illustrates the importance of understanding the neer classification. A 58yearold female slipped and fell and sustained a closed rightsided displaced humerus fracture with a medial butterfly fragment. Proximal humerus fracture book twin cities orthopedics. Surgical treatment of three and fourpart proximal humeral fractures. Surgeons may use nails, plates, and screws to secure pieces of bone together. The humerus is well enveloped in muscle and soft tissue, hence there is a good prognosis for healing in the majority of uncomplicated fractures. Highenergy trauma, fracture location at the middledistal humerus, and simple transverse fracture or comminuted fracture with butterfly fragment seems to be risk factors for radial nerve transection. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side.
The ao classification of proximal humeral fractures, along with the neer classification, is one of the most frequently used systems for classifying proximal humeral fractures. Bone workshop 1994 presented at the american college of veterinary surgeons surgical symposium washington, dc october 28. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Patients with this fracture can often be treated without surgery. Proximal humerus, threepart fracture, fourpart fracture, surgical treatment, orif. Most of the times these heal without requiring surgery, however, some severe cases may require surgical intervention. The clavicle fracture was the most common obstetric bone lesion in our series with a percentage of 77% followed by fracture of the femur and humerus with 12% and 11% respectively.
The proximal humerus is one of the bones in your shoulder joint. Shoulder trauma fractures and dislocations orthoinfo. Reduction is seldom required for humeral shaft fractures. Ce sont toutes les fractures qui siegent au dessus du bord inferieur du grand pectoral elles. The treatment of humerus fracture employs conservative andor surgical methods and successful results are usually obtained from both. From ring et al for very distal comminuted fractures type 1 capitellum and lateral trochlea type 2 is a type 1 with comminution of lateral condyle type 3 is a type 2 with comminution behind capitellum with impaction type 4 is a type 3 with trochlea posterior involvement type 5 is a type 4 with fracture of medial condyle. This type of fracture occurs close to the shoulder joint midshaft humerus fractures. Reproducibility of three classifications of proximal humeral fractures. These are the types of nonoperative ways to handle a humerus fracture cast. The specific etiology of supracondylar humerus fractures in children is not well known. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. They are more common in women than men, and occur more often in older adults.
As the complex nature of capitellar fractures has become better. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Increase rom while protecting the fracture site you can be slightly more. Feb 03, 2020 a proximal humerus fracture is a crack or break in the top of your upper arm bone. To investigate the widely accepted view that an infant with limited. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Limb swelling predating fracture, or marked post fracture swelling. They are also classified as being transverse, oblique, spiral, or comminuted and whether or not they involve a joint. If the fragments are shifted out of position, surgery is usually required. This fracture generally is located in the shaft between the shoulder and elbow joint. Proximal humerus fracture discharge care what you need to. There are three main contributions to the vascular supply of the humeral head. This injury is most commonly a result of a fall onto the affected side or shoulder.
Typical appearances of a minimally displaced proximal humeral fracture involving not only the surgical neck but also the greater tuberosity. Proximal humeral fractures are commonly observed in children who sustain falls whilst running, or from heights. In patient 1, parents of a 5monthold boy fortuitously videotaped their infants unintentional right humeral spiral fracture injury as it occurred in their home. Know the cuases, symptoms, treatment, prognosis, recovery period and complications of closed humeral. Jun 20, 2018 the recovery is near normal with mid shaft humerus fracture. Recovery from fracture is near normal with mid shaft humerus fracture. The expert proximal humeral nail is inserted antegrade into the proximal humeral shaft and can be used universally for either the left or right humerus. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly. The medullary canal of the humerus tapers to an end above the supracondylar expansion. I understand i have the right to change my mind at any time, including after i have signed this form. B, ap radiograph made at 3month followup demonstrating healing and corrected angulation following management with a sarmiento brace. At the elbow, the humerus helps to form the elbow joint. C fractures, provided that the domed head fragment is large enough and that it is not itself fractured.
Fractures of the proximal humerus are common injuries. Jun 10, 2019 a broken upper humerus can make everyday tasks that involve movement of your shoulder very difficult. The humerus is most frequently fractured as the result of a fall or motor vehicle crash. The incidence of fractures of the middle part shaft of the humerus increases with age. The bone typically fractures breaks just below the shoulder, usually after a fall. Humerus fracturetreatmentrecoveryprognosiscausessymptoms. The proximal twothirds of the bone are curved and the distal shaft extends into the condyle. 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. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact. A humerus fracture is a break of the humerus bone in the upper arm. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Humeral shaft fractures pediatric orthopaedic society of.
A broken upper humerus can make everyday tasks that involve movement of your shoulder very difficult. 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. Ao classification of proximal humeral fractures radiology. Coronal plane partial articular fractures of the distal. Figure 2 anteroposterior a, lateral b, and radiocapitellar c views of a displaced bernardmorrey type i capitellar fracture. Humeral fracture in a nonambulant infant younger than 1 year is suspicious for a nonaccidental injury unless there is a credible accidental explanation. Jan 23, 2018 in case of closed humeral fracture, the humerus may get cracked or might get broken but is not exposed. Fractures of the proximal humerus in children and adolescents are. Complications may include injury to an artery or nerve, and compartment syndrome. A proximal humerus fracture is a crack or break in the top of your upper arm bone. Most of these fractures occur without breaking the skin lying over the fracture. Historically, the treatment of choice has been functional bracing.
This is when the proximal humerus is broken into three pieces, and there are then two fracture lines on xray. The supporting evidence is lacking and requires the work group to make a recommendation based on expert opinion by considering the known potential harm and benefits associated with the treatment. In an older person who has weaker bones, however, even a minor fall may be enough to cause a fracture. This is different than a dislocated shoulder, separated shoulder. Affordable and search from millions of royalty free images, photos and vectors. The ao classification divides proximal humeral fractures into three groups, a, b and c, each with subgroups, and places more emphasis on the blood supply to the articular. Fractured surgical neck of the humerus your humerus is the bone in your upper arm. It may happen when your arm or shoulder is hit or used to protect you in a fall. Closed reduction and internal fixation of completely. Return to normal function and motion may require 3 to 4 months overall goals. But when the fracture is located distally, there is a high risk of traction radial nerve injury because the nerve is forcefully pushed laterally for reduction and internal fixation. In evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important.
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