Humeral Shaft Fractures

It is the largest bone in the arm. It is also the only bone in the upper arm. The humerus is connected to many parts such as muscles that help move the shoulder and the elbow. The humerus is so important to many types of actives such as texting, eating and cocktail shaking. The humerus is at the proximal end. The end of the humerus is smooth and round. Because it forms a ball it is connected to the shoulder to form a ball and socket joint. The glenoid cavity of the scapula acting at the socket because of this the humerus can move n full circles and rotate at the shoulder joint. The humerus is a long bone we know this because it is longer than it is wide. It is also a hollow bone which is supported inside by small layers of spongy bone also

The rotator cuff is a group of 4 muscles, the supraspinatus, infraspinatus, subscapularis, and the teres minor. These muscles helps to lift your shoulder up over your head and also rotate it toward and away from your body. Unfortunately, it is also a group of muscles that is frequently injured by tears, tendonitis, impingement, bursitis, and strains. The major muscle that is usually involved is the supraspinatus muscle. Rotator Cuff Injuries are usually broken up into the following categories.

Knowing the anatomy in the regions of injury is vital when solving for the route cause of the pain. When looking at the shoulder, it is important to understand the locations and names of the various muscles and ligament that allow for specific movement for this appendage. For instance, on the superior side of the shoulder joint, the deltoid muscle works with the supraspinatus to abduct the arm at the shoulder. On the anterior side of the shoulder, the coracobrachialis, serratus anterior, pectoralis major, and pectoralis minor muscles work together to flex and abduct the scapula and humerus anteriorly toward the sternum. This knowledge of anatomy becomes advantageous when used to isolate specific areas through palpation exercises in order to further identify and diagnose the presented

IMAGING: X-rays of right shoulder shows interval healing of the proximal humerus fracture on three views.

The deltoid is not technically one of the four muscles directly related to the rotator cuff, but it’s a very important factor in the shoulder. If the supraspinatus is torn, the deltoid becomes the only shoulder elevator. When the deltoid is in use, the posterior and the middle of the anterior depending on the direction of the arm’s elevation, is typically used

The deltoid has three main functions that involve the three individual muscle “strands”. The the anterior deltoid rotates the humerus anteriorly, such as when you reach forward or throw a ball underarm. The lateral deltoid rotates the arm directly out sideways using abduction. The posterior deltoid extends the arm backwards and laterally rotates the arm by pulling the humerus toward

Majority of proximal humeral fractures are either undisplaced or minimally displaced and can be treated with sling immobilization and physical therapy, but approximately

The biceps brachii arises from the scapula by two heads. The long (lateral head) arising from the supraglenoid tubercle, descends within the capsule of the shoulder joint and lies in the intertubercular groove. The short (medial head) arises from the coracoid process in common with the coracobrachialis. The insertion is into the tuberosity of the radius (posterior part) and the fascia of the forearm (and ultimately the ulna) by means of the bicipital aponeurosis. The biceps and brachialis are the chief flexors of the forearm. The origin of the brachialis embraces the insertion of the deltoid. The coracobrachialis is generally pierced by the musculocutaneous nerve.

Allowing for a wide range of movement, the shoulder consists of two main bones the scapula and the humerus with a connecting flexible joint. Arthritis and various shoulder injuries, including a torn rotator cuff or impingement syndrome may cause pain and limit range of motion. Using different shoulder pain management techniques may help in alleviating the symptoms.

Treatment of unstable distal end radius fractures with volar locking plates without additional bone graft can give good results 1,16-18. However, many are of the opinion that the surgical modality is associated with higher morbidity and mortality especially amongst the geriatric age group with approximately 2% of the population with sustained complications within first 30 days of surgery19,20. Contradictory to this notion, the present study had better outcomes in patients who underwent volar plating in terms of range of movements, grip strength, radiological parameters which were statistically significant. Our findings were in consistent with that of Lutz et al19, who prospectively studied 256 patients with distal end radius fractures from several databases and concluded that patients who underwent surgery had better functional and radiological outcome and better DASH

The glenohumeral joint, or shoulder joint, is one of the human body’s appendicular joints and boasts the greatest ROM (range of motion) of any joint in the body. An appendicular joint is a joint that is part of the appendicular skeleton which includes the pectoral girdle, pelvic girdle, and limb bones. The appendicular joints typically have a larger range of motion, but due to this are often weaker than those found in the axial skeleton. The glenohumeral joint is responsible for articulating movement of the upper arm by way of pivoting the humerus at the point that it meets with the scapula.

For the majority of shoulder blade or scapula fractures, the shoulder heals with nothing more than immobilization using a shoulder immobilizer or sling, the application of ice and the dispensing of pain medications. Nevertheless, 10 to 20 percent of patients do require surgery, and this typically happens when the shoulder joint is affected or the shoulder blade and collarbone are both broken. The fracture fragments are then fixed using screws and plates.

For the purpose of evaluation and correct diagnosis it is necessary to correctly classify the fractures and also assess correctly the extent of soft tissue injury. For assessment and classification of peri-articular fractures, the OTA/AO classification is a widely accepted method. (Figure.1) Classification and diagnosis is simplified by breaking the process down into simple algorithms. Type A for any fracture which is completely extra articular. Type B injuries are those intra-articular fractures which have some intact portion of metaphysis. Types C intra-articular fractures are with complete metaphyseal-diaphyseal separation.There are further sub classification in each subgroup. Specific fracture patterns and

more common anterior dislocation, but the shaft of the humerus is parallel to the spine

In the following report, I will be discussing the hypothetical assessment of a young boy ‘Miguel’, who suffered a supracondylar fracture. As he is under 16, he will be accompanied by a parent/guardian who may possibly contribute to the assessment process. Consent should also be given prior to assessment.