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Fracture of the humerus in a shotput athlete
68
Injury: the British Journal of Accident Surgery (1987) Vol. 18/No. 1
Fracture of the humerus in a shotput athlete G. D. Hartonas and D. J. Verettas Department
of Orthopaedic
Surgery, Kavala General Hospital, Greece
CASE REPORT A 19-year-old woman arrived at the Emergency Department of Kavala General Hospital with pain, swelling and inability to move her left elbow. She had sustained an injury while competing in a shotput event, part of the trials for entry to the University Department of Physical Education. On examination there was no vascular or neurological injury distal to the elbow. She was taking no medicines and her past medical history was unremarkable. Radiographs showed an oblique fracture of the distal third of the left humerus with a medial butterfly fragment but no disease of the bone. There was medial and posterior displacement of the fracture (Fig. 1). She was first treated with a hanging plaster-of-Paris cast. Radiographs 1 week later showed the fracture was not reduced and it was therefore fixed with a plate and screws (Fig. 2). Three months later she had a united fracture and a full range of movement of the elbow (Fig. 3).
DISCUSSION Fractures of the humerus are frequent in arm wrestlers (Whitaker, 1977; Heilbronner et al., 1980; Moon et al.,
1980) but in shotputters only one case has been reported (Santavirta and Kiviluoto, 1977); this was a transverse fracture of the middle of the shaft, which was preceded by a few weeks of pain and treated by local cortisone injections. Possibly there was some
disorder of the bone which predisposed to the fracture. In our case there were no similar preceding events to provoke such a fracture The patient was taking no medicines prior to the injury. The throwing mechanism in competitive sports generates an angular velocity of the arm that is.twice that of kicking and an amount of energy four times larger. Throwing is accomplished in three stages: cocking up, a two-stage acceleration and a follow-through. During the second stage of the acceleration the forearm and the hand are projected forwards by the combined action of the internal rotators and the abductors of the shoulder, while at the same time the elbow is extended by the triceps brachii and the forearm is pronated; as a result of this an intense kinetic momentum is produced, aiming at the desired throwing result (Scott et al., 1984). If, however, the follow-through is initiated before the completion of the acceleration, a combination of internal rotation and angulation is applied to a point distal to the insertion of the deltoid muscle; these internally rotating and bending effects are due to the early deceleration (generated by the contraction of the external rotators and abductors of the shoulder) in contrast to the continuing momentum of the arm carrying the unreleased shot. The combination of these moments produces a spiral fracture with a medial butterfly fragment in the distal half of the humerus, as observed in our patient. Like any other fracture at that site, this athlete could have been treated conservatively. However, the position of the fragments 1 week after the initial reduction was unacceptable and led us to perform open reduction and plating.
REFERENCES Heilbronner D. M., Manoli A. and Morawa L. G. (1980) Fractures of the humerus in arm wrestlers. Clin. Orthop. 149, 169.
Moon M. S. et al. (1980) Arm wrestler’s injury: report of seven cases. Clin. Orthop. 147, 219. Peace P. K. (1977) Fractures of the humerus from arm wrestling. Injury 9, 162. Rogers L. F. (1982) Radiology of Skeletal Trauma. New York, Churchill Livingstone, 3.5, 37, 413. Santavirta S. and Kiviluoto 0. (1977) Transverse fracture of the humerus in a shotputter: a case report. Am, J. Sports Med. 5, 122.
W., Nisonson B. and Nicholas J. (1984) Principles of Williams and Wilkins, 114. Whitaker J. H. (1977) Arm wrestling fractures: a humerus twist. Am. J. Sports Med. 5, 67. Scott
Sports Medicine. Baltimore,
b Fig. 1. Lateral (a) and anteroposterior fracture of the distal humerus.
Requests for reprints should be addressed
(b) radiographs of the
Paper accepted 2 April 1986.
to: G. D. Hartonas,
Nafpliou 55-K, Toumpa, Thessaloniki, Greece.
69
Case reports
b
a Fig. 2. Postoperative
radiographs following fixation with a plate and screws.
Fig. 3. Union of the fracture 3 months later.
Injury: the British Journal of Accident Surgery (1987) Vol. 18/No. 1
Fracture of the humerus in a shotput athlete G. D. Hartonas and D. J. Verettas Department
of Orthopaedic
Surgery, Kavala General Hospital, Greece
CASE REPORT A 19-year-old woman arrived at the Emergency Department of Kavala General Hospital with pain, swelling and inability to move her left elbow. She had sustained an injury while competing in a shotput event, part of the trials for entry to the University Department of Physical Education. On examination there was no vascular or neurological injury distal to the elbow. She was taking no medicines and her past medical history was unremarkable. Radiographs showed an oblique fracture of the distal third of the left humerus with a medial butterfly fragment but no disease of the bone. There was medial and posterior displacement of the fracture (Fig. 1). She was first treated with a hanging plaster-of-Paris cast. Radiographs 1 week later showed the fracture was not reduced and it was therefore fixed with a plate and screws (Fig. 2). Three months later she had a united fracture and a full range of movement of the elbow (Fig. 3).
DISCUSSION Fractures of the humerus are frequent in arm wrestlers (Whitaker, 1977; Heilbronner et al., 1980; Moon et al.,
1980) but in shotputters only one case has been reported (Santavirta and Kiviluoto, 1977); this was a transverse fracture of the middle of the shaft, which was preceded by a few weeks of pain and treated by local cortisone injections. Possibly there was some
disorder of the bone which predisposed to the fracture. In our case there were no similar preceding events to provoke such a fracture The patient was taking no medicines prior to the injury. The throwing mechanism in competitive sports generates an angular velocity of the arm that is.twice that of kicking and an amount of energy four times larger. Throwing is accomplished in three stages: cocking up, a two-stage acceleration and a follow-through. During the second stage of the acceleration the forearm and the hand are projected forwards by the combined action of the internal rotators and the abductors of the shoulder, while at the same time the elbow is extended by the triceps brachii and the forearm is pronated; as a result of this an intense kinetic momentum is produced, aiming at the desired throwing result (Scott et al., 1984). If, however, the follow-through is initiated before the completion of the acceleration, a combination of internal rotation and angulation is applied to a point distal to the insertion of the deltoid muscle; these internally rotating and bending effects are due to the early deceleration (generated by the contraction of the external rotators and abductors of the shoulder) in contrast to the continuing momentum of the arm carrying the unreleased shot. The combination of these moments produces a spiral fracture with a medial butterfly fragment in the distal half of the humerus, as observed in our patient. Like any other fracture at that site, this athlete could have been treated conservatively. However, the position of the fragments 1 week after the initial reduction was unacceptable and led us to perform open reduction and plating.
REFERENCES Heilbronner D. M., Manoli A. and Morawa L. G. (1980) Fractures of the humerus in arm wrestlers. Clin. Orthop. 149, 169.
Moon M. S. et al. (1980) Arm wrestler’s injury: report of seven cases. Clin. Orthop. 147, 219. Peace P. K. (1977) Fractures of the humerus from arm wrestling. Injury 9, 162. Rogers L. F. (1982) Radiology of Skeletal Trauma. New York, Churchill Livingstone, 3.5, 37, 413. Santavirta S. and Kiviluoto 0. (1977) Transverse fracture of the humerus in a shotputter: a case report. Am, J. Sports Med. 5, 122.
W., Nisonson B. and Nicholas J. (1984) Principles of Williams and Wilkins, 114. Whitaker J. H. (1977) Arm wrestling fractures: a humerus twist. Am. J. Sports Med. 5, 67. Scott
Sports Medicine. Baltimore,
b Fig. 1. Lateral (a) and anteroposterior fracture of the distal humerus.
Requests for reprints should be addressed
(b) radiographs of the
Paper accepted 2 April 1986.
to: G. D. Hartonas,
Nafpliou 55-K, Toumpa, Thessaloniki, Greece.
69
Case reports
b
a Fig. 2. Postoperative
radiographs following fixation with a plate and screws.
Fig. 3. Union of the fracture 3 months later.