CLOSED FRACTURE 1/3 MIDDLE LEFT HUMERUS

Presented by
Marwah Shamsualam C014181083

Advisors:
dr. Andhika Nur Syamsul Afirin
dr. Erich svante subagio

Supervisor:
dr. Andi Dhedie Prasatia Sam, Sp.OT
 Patient Identity
Name : Ms. M
Age : 44 YO /Female
Admission : Agustus 31th at 2:00am
Registraion : 893995
Status : JKN

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 History taking
Chief Complain : Pain at left arm
✘ Suffered since 10 hours before admitted to Wahidin Sudiro Husodo Hospital
✘ Patient was riding a motorcycle with her sister when her sister’s head covering
was stucked by the gear, causing them to fall to the ground. When she fell, her
left hand outstretched to the ground withstanding her body weight. After
falling, she was unable to lift her left arm due to pain.
✘ There is no history loss of consciousness
✘ There is no history of vomiting
✘ Patient is right hand dominant
✘ Patient was reffered from Latemammnala Soppeng Hospital
✘ There is no history of diabetes mellitus
✘ There is a history of uncontrolled hypertension
✘ Patient wore a helmet
✘ Patient is a housewife
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 PRIMARY SURVEY
A : Clear
B : RR = 20 x/min, symmetric, spontaneous,
thoracoabdominal type.
C : HR: 100 x/min, reguler, strong
Blood pressure 140/70 mmHg
D : GCS 15 (E4 M6 V5), light reflex +/+, pupil
isochors, Ø : 2.5 mm/2.5mm,
E : T = 36.70 C (axillary)

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 SECONDARY SURVEY

Move:
• Active and passive NVD:
movement of Sensibility is
Look: shoulder joint cannot normal. Pulsation
Deformity (+), Feel: be evaluated due to of radialis and
swelling (-), Tenderness (+) pain. ulnaries arteries
hematoma (-), • Active and passive are palpable,
wound (-) movement of elbow Capillary Refill
joint cannot be Time < 2 seconds
evaluated due to pain

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CLINICAL FINDINGS

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LABORATORY FINDING

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RADIOLOGY FINDING

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AO Classification

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RADIOLOGY FINDING

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 DIAGNOSIS
1. Closed Fracture 1/3 Middle Left Humerus
AO Classification 12A.3 IC1 MT1 NV1
2. Hypertension grade I

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 Management

IVFD Apply
Ringer Analgetic Monitor
Lactate slab

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 DISCUSSION
HUMERAL SHAFT FRACTURE

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 Introduction
✘ Fracture: Discontuinity of bone structure either incomplete or complete.
✘ Etiology:
○ Traumatic fracture
○ Pathologic fracture

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Fractures of the humerus
EPIDEMIOLOGY -Most patients are elderly
(>65 years old), representing
comprise approximately 5% fragility-type fractures
to 8% of all extremity
fractures -Younger patients (<30 years
Middle third of diaphysis old) due to high-energy
(60%) trauma
Proximal third of diaphysis
(30%)
Distal third of the diaphysis
Shaft fractures account for (10%)
approximately 3% - 5% of all
long-bone fractures

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1/3 proximal 1/3 middle 1/3 distal
diaphysis diaphysis diaphysis
(30%) (60%) (10%)

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Anatomy of humerus

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Nerves of humerus

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Nerves of humerus

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 UPPER ARM
MUSCLE
(ANTERIOR VIEW )

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 UPPER ARM
MUSCLE
(POSTERIOR VIEW)

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 📌

CLASSIFICATION OF FRACTURE
✘ Communicates With ✘ Etiology ✘ Location
The Outside ○ Traumatic ○ Third proximal
Environment fracture ○ Third middle
○ Open fracture ○ Pathologic ○ Third distal
○ Closed fracture fracture

✘ Intrinsic Condition
✘ Displacement
○ Normal
○ Displacement
○ Osteopenia
○ No displacement
○ Pathologic

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TYPE OF FRACTURE

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 MECHANISM OF HUMERUS INJURY
✘ The most common mechanism is fall onto outstretched upper extremity from
a standing height, with the arm abducted and twist, resulting in an oblique or
transverse fracture.
✘ Younger patients typically sustain a proximal humeral fracture following high-
energy trauma such as a motor vehicle accident
✘ Less common mechanism include :
○ excessive shoulder abduction in an individual with osteoporosis, in which
the greater tuberosity prevent further rotation
○ direct trauma, usually associated with greater tuberosity fractures
○ electrical shock or seizure
○ pathologic processes : malignancy or benign processes in the proximal
humerus
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HOW TO DIAGNOSE? Anamnesis

Physical
Examination

Imaging

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 HISTORY TAKING
• Chief complain: Excruciating pain at the
fracture site, can be swelling, bruising,
deformity, and the presence of open
wounds

• The mechanism of injury

• Additional information should be sought

about comorbidities, previous
treatmant, previous surgery, and habits
that could interfere with anesthetic,
fracture healing, or rehabilitation, such
as smoking, alcoholism, or drug abuse.

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 Physical Examination

Look Feel Move NVD

Swelling, Tenderness is The arm is ✘ Radial and posterior
bruising, commonly found usually swollen interosseous nerve
deformity, or and tender and ✘ Compartment pressures.
the presence of the patient will
open wounds be unwilling to ✘ Assess for the presence
move the arm of radial and ulnar artery

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 IMAGING

1. X-Ray
AP and lateral views of the humerus, including the joints
below and above the injury.

2. Computed Tomographic (CT)

Associated intra-articular injuries proximally or distally
and may also be indicated in the rare situation where a
significant rotational abnormality exists as rotational
alignment is difficult to judge from plain radiographs of a
diaphyseal long bone fracture.

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MANAGEMENT OF FRACTURE

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 TREATMENT

TREATMENT
GOALS

CONSERVATIVE OPERATIVE

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 CONSERVATIVE
Most humeral shaft fractures (>90%) will heal with
nonsurgical management.
Nonoperative treatment requirements are:
 An understanding by the treating physician
of the postural and muscular forces to be
controlled
 Close patient supervision and follow-up
 A cooperative and preferably upright and
mobile patient
 An acceptable fracture reduction
 Intact/innervated arm musculature (e.g.,
intact brachial plexus)
Twenty degrees of anterior (sagittal) angulation, 30
degrees of varus (coronal) angulation, and up to 3 cm of
bayonet apposition are acceptable and will not
compromise function or appearance.
Most treatment begins with application of a coaptation
spint or a hanging arm cast followed by placement of a
fracture brace
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METHOD FOR CONSERVATIVE THERAPY

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 OPERATIVE
Indications for operative treatment
include:
■ Multiple trauma
■ Pathologic fracture
■ Associated vascular injury
■ “Floating elbow”
■ Segmental fracture
■ Intra-articular fracture extension
■ Bilateral humeral fractures
■ Open fracture

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 EARLY COMPLICATION

Vascular Compartment
Nerve Injury Infection
Injury Syndrome

LATE COMPLICATION

Malunion Delayed Union Non Union

 thanks!
Any questions?

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