FRAKTUR HUMERUS PROKSIMAL

Mechanism of Injury
Fall onto an outstretched hand, especially common in older adults with osteoporosis
Direct blows such as falling onto the shoulder
The most common site is collum chirurgicum

Pathophysiology
Tuberculum majus is pulled posteromedially by m. supraspinatus and infraspinatus
Tuberculum minus is pulled anteriorly by m. subscapularis
Corpus humeri is pulled anteromedially by m. pectoralis major

Classfication (Neers Classification)

Proximal humerus is divided into 4 fracture segments : Tuberculum majus, tuberculum minus, caput
humeri, and corpus humeri
 Non displaced proximal fractures although there are many
fracture lines
One-part fractures
Displacement defined as greater than 450 of angulation or 1 cm
or separation, regardless of the number of cleavage lines
Two-part fractures One fragment is displaced or angulated
Two fragments are displaced or angulated
Three-part fractures
Caput humeri remains in cavitas glenoidalis
Three or more fragments are displaced or angulated
Four-part fractures
Caput humeri dislocated from the cavitas glenoidalis

Clinical Presentation
Diffuse shoulder pain
Hold the injured arm against the side and resist movement
Ecchymosis on the upper part of the arm

Radiology Examination
Two AP views with upper arm in internal and extenral rotation
Transcapular view (Y view)
Axillary view

Neurovascular Complications
Fracture of collum chirurgicum cause avascular necrosis of caput humeri due to rupture of a.
circumflexa humeri anterior
N. axillaris
FRAKTUR CORPUS HUMERI

Mechanism of Injury
Direct blow or bending force to the middle humerus
Fall onto an outstretched arm or elbow
Violent muscle contraction such as in weight lifting

Pathophysiology
Above the Deltoid Insertion Below the Deltoid Insertion
Proximal segment Pulled medially by m. pectoralis major Pulled laterally m. deltoideus
Distal segment Pulled proximally by m. biceps brachii and m. triceps brachii Shortening

Clinical Features
Swelling and pain of the mid-upper arm
Shortening of the arm

Radiology Examination
AP and lateral views of the humerus

Neurovascular Complications
N. radialis

DISLOKASI BAHU ANTERIOR

Mechanism of Injury
Excessive extension and lateral rotation of humerus
Hard blow to the humerus when the joint is fully abducted
Pathophysiology
Capsula articularis may be tear Caput humeri lie inferior to the cavitas glenoidalis
The strong flexor and adductor muscles of the articulatio humeri pull the caput humeri
anterosuperiorly into subcoracoid position

Clinical Features
Arm held firmly in slight abduction and slight external rotation
Severe pain and avoids joint movement
Loss of normal rounded contour of the shoulder
Caput humeri may be palpated below the processus coracoideus

Radiology Examination
 AP view and
Transcapular view

Neurovascular Complications
N. axillaris
Rotator cuff tear