Fracture in the arm

Fracture in the arm

1. Anatomy of the arm

   • bone structure
     • bone ossification
       • intramembranous
       • endochondral
   • arm divided by inter muscular septa
     • anterior compartment
       • muscles of the arm
         • biceps
           • long head origin: supraglenoid tubercle
           • short head origin: coracoid process
           • insertion: radial tuberosity
         • brachialis
           • origin: lower 1/2 of anterior surface of humerus
           • insertion: ulnar tuberosity
         • coracobrachialis
           • origin: coracoid
           • insertion: middle of medial aspect of humerus
         • all innervated by musculocutaneous nerve
     • posterior compartment
       • triceps
         • long head origin: infraglenoid tubercle
         • lateral head origin: upper 1/2 of posterior surface of humerus
         • medial head origin: lower 1/2 of posterior surface below spiral groove
         • innervated by branches of radial nerve
         • insertion: olecranon process of ulna
   • humerus
   • nerves
     • branches and continuation of the brachial plexus
       • ulnar
         • branch of medial cord
       • median
         • later cord root and medial cord root
       • musculocutaneous
         • branch of lateral cord
       • axillary
         • branch of posterior cord
       • radial
         • branch of posterior cord
   • Blood Vessels
     • Brachial Artery
       • continuation of axillary artery
         • starts at lower border of teres major
     • Brachial Vein
       • forms from
         • branches of brachial artery
           • venae comitantes
         • basilic vein

2. Fractures

   • break in the structural continuity of bone tissue
     • how they occur?
       • trauma
         • repititive stress
           • pathological conditions
     • TYPES
       • spiral
       • oblique
       • butterfly
       • transverse
     • clinical picture
       • pain
         • swelling
           • loss of function
             • deformity
               • hematoma, echymosis
     • leads to damage of surrounding soft tissue
       • Nerve injury
         • neurapraxia
           • demyelination of the axon
         • axonotemesis
           • disruption of axon
             • neural tube is intact
         • neurotemesis
           • neural tube is not intact
   • transverse mid-shaft humeral fracture
     • damage to radial nerve
       • Wrist & Finger drop
         • paralysis of the extensors in the forearm and supinators and pronators
   • Diagnosis
     • X-ray
       • AP view
       • lateral view
     • MRI
     • CT scan
   • Management
     • Appropriate Reduction
       • closed
         • not surgical, using manoeuvres
       • open
         • using surgical equipment
     • Maintain Reduction
       • External
         • casts, traction, plaster of paris
       • internal
         • screws, nails, plates
     • Rehabilitate
       • Physiotherapy
         • shoulder,elbow & wrist ROM to regain full ranges and muscle strength
     • Prevent & treat complications
       • Delayed Union
       • Misunion
       • Nonunion
     • BONE HEALING