HUMERAL

A. Anatomy
Distally 2 condyles forming articular surfaces of trochlea and capitellum
Proximally neck and head articulate with glenoid fossa of scapula
1



B. Fracture
Head - Direct trauma to the humerus from collision with an object or fall directly onto
the bone
Shaft bent forces like breaking a stick (shear or torsion)
Supracondylar upper transmission of force on outstretched hand

a) Humeral Head Fracture
Upper humeral fractures usually involve the surgical neck of the bone
extracapsular
low incidence of avascular necrosis (AVN)
Anatomical Neck
intracapsular
higher incidence of AVN


Treatment for humeral head fracture:
One part fractures (no fracture fragments displaced < 1cm or 45 deg)
Non-operative immobilization in sling1-2 weeks
Early motion started immediately
75% good to excellent results; 10% poor
Any other fracture
Closed reduction with percutaneous pinning
ORIF
2-6 weeks to allow pain free movement
One part fractures are when patients can actively move the extremity. Passive
movement produces minimal pain and no bone movement noted. Generally, immobilization >
2 weeks will lead to stiffness.
Complication of humeral head fracture :
Avascular Necrosis of Humeral Head
Especially at risk with 4 part fractures
Non-union
3-6 mos after injury
Shoulder stiffness with prolonged immobilization

b) Humeral shaft Fracture
1-3% of all fractures
Up to 18% have radial nn palsey
Mechanism of Fracture :
- bending force produces transverse fracture of the shaft;
- torsion force will result in a spiral fracture;
- combination of bending and torsion produce oblique fracture with or without a butterfly
fragment;
- compression forces will fracture either proximal or distal ends of humerus;
Types of humeral shaft fracture :
- transverse humeral fractures:
- distal third fracture
- short oblique fractures

c) Suprecondyler Fracture
Most common pediatric elbow fracture (65% of fractures and dislocations of the
elbow)
Commonly associated with neurovascular injury
In children, supracondylar fracture typically remains extra-articular & involves thin bone
between coronoid fossa & olecranon fossa of distal humerus. Fracture line angles from
anterior distal point to posterior proximal site. In adults, supracondylar fracture of humerus
may be intra-articular. Fracture occurs most often around age 6-7 years;
1) Bayley, E. Ski Injuries for the Upper Extremitas.
http://www.scribd.com/doc/50845699/Upper-Extremities#download. Diunduh
tanggal : 10 Agustus 2012.
2) Solomon, L., Warwick, D., Nayagam, S., 2010. Apleys System of Orthopaedics
and Fracture. Ninth Edition. Section 23-31. Hachette UK Company : London.