M.E.Müller: Atlas: Fracture 12-A1

Humerus, Diaphysis,
simple fracture, spiral 0,24% of the total
3,37% of the humerus
15,22% of the segment

30 fractures 22,7% group
53%M, 47%F

60 fractures
45,5% group
50%M, 50%F

42 fractures
31,8% group
53%M, 47%F

Proximal section Middle section Distal section

These are simple fractures of the humeral diaphysis with a spiral fracture line, thus with a broad contact surface once reduced. The subgroup indicates the diaphyseal level of the fracture. Ref. Manual of Internal Fixation:
232 - 251. 442 - 445.
Surgeon. RO, RO, RO.

The conservative treatment is generally accepted even though, in practice, a stable anatomic reduction is almost impossible to obtain by bloodless methods. One frequently attains a sufficient alignment with slight shortening, relatively able to be stabilized by external splints or bandages. The fibrous callus formation process is fast. In optimal conditions, several stability factors (shortening, external splints and early callus) add up to result in enough neutralization of the forces at the fracture site. Under these circumstances, the fracture put at rest heals with acceptable functional results.

In the A1.1 fractures, where the action of the deltoid muscle predominates over the proximal fragment, the reduction is impossible in obese patients or in women with large breasts. A delayed union frequently develops in older or in uncooperative patients, requiring surgical repair. In these cases, an embedded reduction can be performed by introducing the sharp point of the proximal fragment into the medullary canal of the distal fragment.

The fracture is then stabilized by a contoured plate with few screws. If at all possible, one of the screws should perform interfragmentary compression. Autologous bone graft must be added.

The fractures of the A1.2 subgroup are easier to stabilize with external splints than the .1 and .3 fractures. If an internal fixation is indicated, the plate size must be proportionate to the bone. In the illustrated .2 case, the bone is quite small and was treated with a one third tubular plate. The most important point is to perform interfragmentary compression with one or two lag screws, preferably inserted through the plate. The A1.3 subgroup is the most difficult to treat by conservative methods and this is why the indication of internal fixation is more frequent in this subgroup. Injury to the radial nerve, here in an even more dangerous location than in other levels, must be avoided.

preoperative postoperative + 1 year

preoperative 0 months + 1 months + 1 months

+ 3 months + 3 months + 4 months + 4 months

preoperative preoperative 0 months + 1 months

+ 3 months + 3 months

preoperative + 8 months preoperative + 8 months

preoperative + 3 months + 3 months

+ 6 months + 6 months




						Humerus, Diaphysis, simple fracture, spiral	0,24% of the total 3,37% of the humerus 15,22% of the segment






These are simple fractures of the humeral diaphysis with a spiral fracture line, thus with a broad contact surface once reduced. The subgroup indicates the diaphyseal level of the fracture.		Ref. Manual of Internal Fixation: 232 - 251. 442 - 445. Surgeon. RO, RO, RO.

The conservative treatment is generally accepted even though, in practice, a stable anatomic reduction is almost impossible to obtain by bloodless methods. One frequently attains a sufficient alignment with slight shortening, relatively able to be stabilized by external splints or bandages. The fibrous callus formation process is fast. In optimal conditions, several stability factors (shortening, external splints and early callus) add up to result in enough neutralization of the forces at the fracture site. Under these circumstances, the fracture put at rest heals with acceptable functional results. In the A1.1 fractures, where the action of the deltoid muscle predominates over the proximal fragment, the reduction is impossible in obese patients or in women with large breasts. A delayed union frequently develops in older or in uncooperative patients, requiring surgical repair. In these cases, an embedded reduction can be performed by introducing the sharp point of the proximal fragment into the medullary canal of the distal fragment.	The fracture is then stabilized by a contoured plate with few screws. If at all possible, one of the screws should perform interfragmentary compression. Autologous bone graft must be added. The fractures of the A1.2 subgroup are easier to stabilize with external splints than the .1 and .3 fractures. If an internal fixation is indicated, the plate size must be proportionate to the bone. In the illustrated .2 case, the bone is quite small and was treated with a one third tubular plate. The most important point is to perform interfragmentary compression with one or two lag screws, preferably inserted through the plate. The A1.3 subgroup is the most difficult to treat by conservative methods and this is why the indication of internal fixation is more frequent in this subgroup. Injury to the radial nerve, here in an even more dangerous location than in other levels, must be avoided.