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. Modified combined approach for distal humerus shaft. Failed orif and nonunion of distal humerus fractures. Distal humerus fractures in adults are relatively uncommon injuries, representing only about 3% of all fractures in adults. Fracture proximal humerus 5% of all fractures of all the fractures of the proximal humerus. Nondisplaced means less than 1cm of displacement and less than 45. Proximal humerus fracture rehabilitation researchgate. A 6 mm lucency involving the distal aspect of the fracture between the two major fracture fragments was concerning for non. Whether pinning the fracture or using open reduction internal fixation orif, other points to remember include anatomic reduction of the tuberosities, as. Discussion a variety of fractures of the humerus may occur. Need for alignment and stabilization of bone fractures 2. Historically based on radiographs and fracture classification. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy.
Management of proximal humerus fractures in adults leonidas vachtsevanos, lydia hayden, aravind s desai, asterios dramis. Phase i 0 to 21 days begin elbow, wrist and hand active rom. Learn the epidemiology of proximal humeral fractures. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients. A distal humerus fracture is a break or crack that involves the distal region of the humerus, which forms the upper part of the elbow joint and lower portion of the arm it is usually caused by a highenergy impact that results from an athletic sport, motor vehicle accident, or a. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. Nonoperative proximal humeral fracture rehabilitation protocol.
There is currently insufficient evidence to suggest superiority of one treatment option over the others. The system is intended for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus, particularly in osteopenic bone. Electrotherapy or hydrotherapy does not enhance recovery. In some cases, the broken proximal humerus must be surgically repaired or replaced. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. Also a humeral brace is described which can be used in the initial treatment or in the treatment of fractures in the distal third of the humerus. The supracondylar humerus fracture schf is one of the most common fractures in children, predominantly the extensiontype.
Axial and coronal ct images better delineate an essentially shattered proximal humerus. If a fracture or fracture repair is stable, then therapy should be started early. Helfet, md at the orthopedic trauma service of hospital for special surgery 4 months following her fracture and radiographs revealed a nonunion. Distal humerus fracture arm fracture treatment options. Functional bracing of fractures of the shaft of the humerus.
Challenges of proximal humerus fractures alexandra k. Operative versus nonoperative treatment for twopart. Nonoperative treatment of proximal humerus fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. Optilock upper extremity plating system proximal humeral. Definition realignment and fixation of a fracture of the arm necessitating an operative incision. The humerus is most frequently fractured as the result of a fall or motor vehicle crash. Aim of this study was to evaluate outcomes of operative as compared to conserveative treatment for twopart humerus fractures at the surgical neck. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills.
Complex fracture of the proximal humerus treated with shoulder prosthesis a. A distal humerus fracture is a fracture of the lower end of the humerus arm bone that forms part of the elbow joint. Bimodal anterolateral and lateral approach for distal humerus shaft fracture clinics in orthopedic surgery vol. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. Humerus fracture broken upper arm physical therapy library. Distal locking was performed using a freehand technique. They typically occur in older patients, most of them women.
Handoll h, brealey s, rangan a, torgerson d, dennis l, armstrong a, et al. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. A 64yearold female sustained a leftsided proximal humerus fracture aoota type 12a2. Pele and another v road accident fund 315092014 2017. Surgeons may use nails, plates, and screws to secure pieces of bone together. Distal humerus fracture a distal humerus fracture is the term used to describe a type of elbow fracture where the lower end of the upper arm bone humerus has been broken. A drill sleeve is inserted through a stab incision after soft tissues have been dissected bluntly down to bone. Any surgical intervention should have clear aims and indications and the appropriate technique should be selected for each individual patient. Open fracture foster et al, jhs, 1993 14 patients with open fractures 64% 9 with nerve injury interposed. It is a relatively uncommon injury in adults, accounting for only about 2% of fractures. A 3fold increase in osteoporosisrelated fractures is expected in the year 2030 2, 3. Status post closed reduction and percutaneous pinning of this displaced supracondylar humerus fracture.
Surgical treatment for a proximal humerus fracture. Shoulder arthroplasty for acute proximal humerus fracture. The injury may also occur in younger individuals often resulting from highenergy trauma from cycling or vehicular accidents. Lphp, philos and phn for proximal humerus fractures were evaluated in this. There is also an impaction fracture of the glenoid. Earlier rehabilitation ability to treat more fractures with orif vs hemi or nonop. Nonoperative management of proximal humerus fractures. Proximal humerus fractures pediatric orthopaedic society. If closed reduction and immobilization are unsatisfactory or when there is nounion, fixation may be achieved by using a number if internal fixation devices, including screws, rods, and compression plates. Data from a prospective multicentre cohort study on four treatment options conservative treatment and three implants, i.
The pdf of the article you requested follows this cover page. Children are more likely to suffer this type of injury. Before the distal screw was inserted, the fracture site is. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. Courtbrown found that 70% of all 3 and 4part fractures are seen in patients aged over 60 years and 50% in patients aged over 70 years. Most found good results in terms of pain, but much less satisfactory functional outcome. Radiographs showed an oblique displaced fracture extending through the midshaft of the humerus with mild apex lateral angulation figure 1. As the median and radial nerves lie anterior to the supracondylar humerus region they are at risk for injury, primarily posttrauma either by stretching, piercing or impinging at the fracture ends or being entrapped. Fashion removable longarm splint holding the elbow in 90 degrees of. She was taken by ambulance to the tygerberg hospital.
In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation between 19% and 30%. The preferred treatment varies depend on the patients age and bone \ud quality, the expertise\ud,\ud surgical team and the patients expectations. Fractures of the upper end of the humerus that interrupt the blood supply to the humeral head may justify a prosthetic replacement. In a study of 4536 consecutive fractures in adults seen in the massachusetts general hospital emergency department, only 0. She was then transferred to the kuils river hospital and admitted to the icu for three weeks for treatment of her head and rib fractures. Rehabilitation is central to addressing the problems caused by the fracture. Nonoperative management is associated with good outcomes in the majority of proximal humerus fractures in adults. The most important factor for hardware failure is poor initial fixation, which can be difficult to achieve in the presence of extensive. A humeral shaft fracture complicated with anterior. Distal humerus fractures occur in less than 2% of cases, thus are fairly rare. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Pdf proximal humerus fractures current treatment options. A rigorous a rigorous analysis of the patients condition and the type of fracture is a prerequisite before rejecting an indication of orthopedic treatment or fixation. When a trauma surgeon is faced with a complex fracture and poor bone quality, determining the surgical indication and.
Fractures of the proximal humerus are the third most common type of fracture. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Exercises for fracture of proximal humerus variant image id. Patient selection factors to be considered include. Although the appropriate management of displaced or unstable proximal humeral fractures remains a controversial, open reduction and internal fixation orif using fixedangle interlocking plate. Maintain rom without displacing the proximal humerus fracture. Outcome analysis following removal of locking plate. Distal humerus orif fracture early motion therapy protocol. Proximal humeral fractures are relatively uncommon fractures, accounting for 5% of all fractures at an incidence of 66100,000 person.
Closed fracture pollack et al, jbjs, 1981 24 radial nerve palsies incidence. The role of nerve exploration in supracondylar humerus. Protocol for the profher proximal fracture of the humerus. Nonunion is a challenging complication of distal humerus fractures and has a reported incidence of eight to 25% in recent series 16. The most useful rehabilitation protocol is the threephase system. Complex fractures of the distal humerus in the elderly. Supracondylar and lateral condyle fractures of the humerus. Hemiarthroplasty is the procedure of choice for certain 3 and 4part fractures, fracturedislocations, and headsplitting fractures of the proximal humerus. Distal humerus fracture open reduction and internal fixation. Proximal humeral fractures are typically treated successfully using. The proximal humeral physis contributes approximately 80% of the growth of the humerus. The injury usually results from a fall and commonly occurs in individuals over the age of 60 years. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. The midshaft fracture appeared separate from the healing.