Abstract
Fractures of the shaft of the humerus are usually easy to treat, irrespective of the personality of the fracture.
The blood supply is abundant that union is rapid. There is no tendency to over-riding; on the contrary, the only danger is that the fragments may be allowed to distract by the weight of the limb and cause delayed union. The middle third is the most vulnerable in relation to delayed or non-union. This is because the main nutrient artery enters the bone very constantly at the junction of the middle and lower thirds or in the lower part of the middle third. The radial nerve is another structure at risk from fractures or operations on the humerus. It does not travel along the spiral groove of the humerus next to the bone as is commonly described; instead along most of its course it is separated from the humerus by a variable layer of muscle, and lies close to the inferior lip of the spiral groove.
In general treatment of the fractured shaft of the humerus is not usually difficult. The fractured ends can be readily aligned with the patient sitting, when the weight of the forearm on the distal fragment will usually achieve an acceptable position. Support of the wrist a collar and cuff or narrow sling, allowing the elbow to lie free and unsupported may be all that is required. In the early stages when there is considerable pain a well padded plaster of Paris U-slab passing from the region of the acromion down to the olecranon and up the inner side of the arm to the axilla and bandaged in place is very effective in relieving discomfort. After two weeks the collar and cuff bandage can be replaced by a functional orthosis type Sarmiento for another four to six weeks. A “ hanging cast” popularized by Caldwell is no longer recommended because it may distract the fracture and produce delayed union.
Theses abstracts were prepared by Professor Dr. Frantz Langlais. Correspondence should be addressed to him at EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
