Fractures of the diaphysis of the humerus


 * are caused by direct and indirect mechanisms (blow, fall, ...)
 * frequent fracture during overstretching (popularly lever) due to torsional force
 * definition of the diaphysis of the humerus - proximally the tendon of the m. pectoralis major, distally 4 cm above the elbow

AO classification
A – simple (I – spiral, II – oblique, III – transverse)

B – wedge-shaped (I – spiral wedge, II – bending wedge, III – split wedge)

C – complex

dislocation of the proximal fragment (according to this, then adduction or abduction fracture)


 * fracture above the tendon of m. deltoideus – traction m. pectoralis major into adduction
 * fracture above the tendon of m. deltoideus – traction m. deltoideus into abduction

Clinical signs and diagnosis

 * classic symptoms of fracture (pain, deformity, pathological mobility, oedema and heematoma, crepitations)
 * it is necessary to examine the pulse on the a. radialis and innervation of the nervus radialis (sensitivity + motor - wrist and finger extensions)
 * X-ray in two projections (also view of adjacent joints - shoulder + elbow)

Complications

 * n. radialis and a. brachialis injuries (it is necessary to examine innervation + pulse of a. radialis)
 * Late complications include the formation of a tuberosity and irritation of the n. radialis by hyperthrophic muscle

Conservative

 * repositioning,
 * fixation (hanging cast, Desault, abduction splint, circular brace - functional treatment according to Sarmiento),
 * early warm-up of the shoulder
 * acceptable for conservative treatment are dislocation up to ½ diaphyseal width, shortening up to 1 cm, angulation up to 25°, immobilization for 4-12 weeks,

surgical

 * if not repairable, concomitant neurovascular injury, open fractures
 * nitra-articular osteosynthesis (most common - secured nail, ante- or retrograde) - transverse, short oblique and splinter
 * splint osteosynthesis (DCD – dynamic compression plate) – spiral and long-angled fractures, injuries of the n. radialis
 * external fixation – open fractures with soft tissue damage, polytrauma

Related articles

 * Fractures of the humerus