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Fractures of the shaft of the humerus

Background
  • Fractures of the shaft of the humerus account for approximately 3 % of all fractures.
  • Majority treated via non-surgical means successfully.
  • Low energy # amenable to closed treatment due to internal soft tissue splinting.
  • Shaft = from pec. major insertion prox. to supracondylar ridge distally. Anterolat. surface contains deltoid tuberosity, sulcus for profunda brachii and radial nn., spiral groove posteriorly contains radial nn distally.
  • Musculature – intermusc septum divides into ant. and post compartments: post – triceps brachii; Ant – biceps, coracobrachialis and brachialis. 
  • The humeral diaphysis derives its blood supply from nutrient vessels, and a periosteal supply dependant on muscular branches and the anastomosis around the elbow.
  • Muscular attachments of the deltoid and pectoralis cause differing degrees of displacement depending on the level of the fracture and affect the choice and success of non-operative management.
  • Nerves – 

    - Musculocutaneous 5-8 cm distal to coracoid pierces coracobrachialis supplies to coracobrachialis, biceps and brachialis and brachioradialis.

    - Median – accompanies brachial a. medial to shaft and distally crosses lateral to medial (wrt artery). Lies medial to artery insertion in antecubital fossa.

    - Radial – spiral around shaft from medial to lateral. Supplies post compartment and part of brachioradialis. Emerges between brachialis and brachioradialis in lat. third of arm. ALWAYS document RADIAL fct peri-op.

    - Ulnar – travels down medial to brachial a, behind medial epicondyle.
  •  Vascular – shaft receives supply from brachial a, Nutrient and periosteal br. may arise from brachial, profunda brachii, post humeral circumflex a.
  • The fracture can be classified using the AO classification, or by site, fracture personality – transv, oblique, spiral; soft tissue injury including vascular and nerve injury and intrinsic conditions of the bone.
  • Holstein-Lewis# = spiral # distal third that MAY be assoc with radial n. injury.
  • Always consider adjacent joints, bone quality, pt factors.

AO Classification

 



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