الفهرس 
List of Contents.Only 14 pages are availabe for public view
 |  | from | 178 |  |  |
| | | from | 178 | | |
Abstract
Acute humeral shaft fracture in adults is a common injury. It account for about 3% of all fractures. They may result from different mechanisms of injury secondary to direct trauma (the most common) to the arm results in transverse fractures or comminuted fractures or due to indirect forces and this will lead to spiral or oblique fractures.
Adult patients with acute humeral shaft fractures typically present with pain, swelling, deformity and shortening of the affected arm. Standard radiographic evaluation of the humerus should include anteroposterior and lateral views with shoulder and elbow joints on each view. Computed tomography (CT), technetium-labeled bone scans and magnetic resonance images (MRI) are rarely indicated except in cases in which pathologic fracture is suspected. Careful evaluation and documentation of the neurologic status of the limb (by motor and sensory examinations) is critical. The vascular status of the entire limb should be evaluated at multiple levels by duppler and angiography.
Humeral shaft fractures are classified as closed or opened. Fractures may be undisplaced or displace with varying degrees of translation. In addition, fractures can be classified according to associated injury (either vascular or neurological), associated soft tissue injury, direction of fracture line, fractures in adults or in children and AO classification.
The aim of management of acute humeral shaft fractures in adults is to establish a solid union with an acceptable humeral alignment and to restore the patient to preinjury level of function. Both patient and fracture characteristics need to be considered when selecting an appropriate treatment option.
Bone fracture healing runs in three distinct phases. The first stage is the inflammatory stage, the second stage is the reparative stage and the last stage is the remodeling stage.
The most of acute humeral shaft fractures in adults (> 90%) will heal with nonsurgical or conservative management and the rate of union is high, whereas that of nonunion ranges from 1% to 6% but become more common in those surgically treated. Multiple closed or conservative techniques are available including hanging arm cast, coaptation or U-shaped brachial splint, thoracobrachial immobilization (velpeau dressing), shoulder spica cast (abduction humeral splint), skeletal traction and functional bracing.
However, there are absolute and relative indications for surgical treatment of acute humeral shaft fractures in adults. There are many surgical approaches for humeral shaft including anterolateral, anteromedial, posterior and lateral approach. Anterolateral and posterior approaches are most commonly used.
Among the most frequently used surgical techniques, the following are included as open reduction and plate fixation, intramedullary fixation and external fixation which is indicated in the burned patients with.
Postoperative Rehabilitation involves range-of-motion exercises for the hand, wrist, elbow and shoulder.
Complications of acute humeral shaft fractures in adults include radial nerve injury, vascular injury, non-union, malunion, infection, loss of shoulder and elbow motion, compartment syndrome, reflex sympathetic dystrophy, fat embolism and late refracture may occur from retained internal fixation.