FRAKTUR HUMERUS

A. ANATOMI

Humerus AP Indications for imaging Trauma - dislocations, fractures, soft tissue calcifications Arthritis survey Bone pain. Anatomy Demonstrated

Humerus Anatomy AP Rt (from) Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Basic Patient Position The patient stands erect AP, the position of the film is adjusted to included the shoulder and elbow joints. The patients arm is abducted approximately 20 degrees and externally rotated to bring the distal epicondyles equidistant from the film, the patient may need to be rotated to the affected side. The humerus may need to be positioned diagonally across the film to included the full length.

Humerus Anatomy AP Lt Patient Position Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Radiation protection Direct lead rubber gonad protection using a "half apron". Avoid irradiating the thyroid and breast tissue as much as possible. Central Ray The horizontal central ray is centered midway between the skin surfaces at the midpoint of the humerus. Exposure is made on suspended expiration. Exposure Factors Kv 80 mAS 6 FFD (cm) 100 Grid No Focus Fine AEC No Cassett e 24x30 cm

Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film. Limits of the examination, superiorly the shoulder inferiorly the proximal 3cm of the forearm, medially the gleno humeral joint and laterally the skin surfaces. Evidence of collimation on four sides equally around the centering point The humeral head should be minimally superimposed on the glenoid and the greater tuberosity should be in profile. Distally the elbow joint should be projected in a true AP position, with he distal epicondyles in profile. The exposure should demonstrate all the soft tissues and penetrate the denser proximal portion without over exposure of the less dense distal portion, utilisation of the anode heal effect, anode side of the tube inferiorly may help to reduce the exposure to the distal portion.

Humerus fracture Proximal fracture

Characteristics
Common in the elderly osteoporotic population following a fall onto outstretched hand. Depending on the forces applied, dislocation can occur concomitantly. Classified by Neer depending on the number and displacement of segments. The four segments described are: head, greater tuberosity, lesser tuberosity and shaft. Displacement is defined as separation of 1cm or 45 degrees of angulation. Clinical features The patient will complain of pain and be reluctant to move the arm. Again the patient may support the elbow with the contralateral hand. Deformity may be present with associated bruising and/or fracture crepitus. Check and document axillary nerve function. Radiological features AP combined with an apical oblique or a trans-lateral view is necessary to identify the fracture, but also to delineate the angulation. Fracture line should be assessed according to the Neer classification. A lipohaemarthrosis may be visible as a fat/fluid level inferior to the acromion process. A significant haemarthrosis may displace the humeral head downwards resulting in a pseudo-subluxation. Look for an associated dislocation (anterior or posterior). Management ABCs. With minimally displaced fractures, initial treatment consists of good analgesia and immobilisation in a broad arm sling or collar and cuff.Where disimpaction is undesirable a broad arm sling is recommended.A collar and cuff will allow gravitational correction of an angulated deformity. The patient should be encouraged to mobilise with passive movements followed by more active exercises once clinical union has occurred. Two, three and four part fractures with displacement should

be referred to the orthopaedic team as surgical repair may be indicated. Fracture dislocations (except simple dislocations with a greater tuberosity fracture) should also be discussed with the orthopaedic team.The principle of relocation followed by fracture treatment applies. Beware as forceful reduction can separate previously undisplaced fractures and thus closed reduction with X-ray screening is advised. 5 Upper Limb