A series of seven cases is presented in which similar fractures of the distal shaft of the humerus occured during the throwing of hand grenades. Neurologic deficit of the radial nerve accompanied the fracture in two patients. In five of the patients, the fracture healed without any complication. The other two are new fractures and still in follow process. The mechanism of the fracture is discussed with reference to the literature. Most textbooks do not give any knowledge about this type of injuy. With our reports; we want to show the possibility of this spesific kind of fracture that can occur without any trauma during hand grenade throwing. In our cases we also want to find the critic number of the throw that affect to the occurence of the fracture. ** The study was performed at the Orthopaedics and Traumatology Clinics of Girne Military Hospital, Via Mersin, Turkey. Introduction The most frequent cause of fracture of the humerus is a direct trauma [12]. Fractures of the shaft of the humerus as a result of musculer violence are uncommon[345678]. Also fractures of the humeral shaft during a throw are relatively rare. Although they have been reported for various thrown objects including hand grenades, jawelins, shot-puts, cricket balls, stones and snowballs[9], the items most frequently thrown are balls; hence, the injury’s name. The fracture is almost always the result of a full-effort throw that is often accompanied by an audible crack or snap. These fractures are spiral in nature and usually are located between the middle and distal third of the humerus. Ball-thrower’s fracture is generally accepted to result from intense torsion upon the humerus during the acceleration-phase of the throw. Within a 14 months period, from 12/2007 to 02/2009, we treated seven patients for distal spiral oblique fracture of humerus(Ball-thrower’s fracture) in hand grenades throwers. All seven patients were injured during throwing of hand grenades in their training period and treated at the Department of Orthopaedic Surgery of Girne Military Hospital, Via Mersin, Turkey. Patients And Methods In all cases, the injury occured during throwing of hand grenades in their training period. The hand grenades were all; in 12.5 cms length ,17.5 cms diameter and 800 grs mass(Turkish type). All ?njuries happened during a 40 metres distance throw. Most of the injured recruits were transported the hospital immediately after the accident. Pathological movement, tenderness, crepitation were found in all patients. The angulation was anterolateral in all cases. Their throwing sequence, in which the fracture occured, is asked to the recruits and noted. Two patients were found to have radial nerve deficit, possibly due to a reduction attempt in the field after the misdiagnosis of an elbow dislocation. After manuplation and application of hanging cast the fracture position is utilized in the same day and three days after the injury. The position of the hanging cast is corrected if there is any more angulation on the fracture side. Four patients operated; because of an unacceptable varus angulation(>10 degrees) and probable occurence of shortness(>3 cms) on the fracture side during the healing process. Two of them are treated with plate-screw osteosynthesis, one is treated with three cerclage wires and the other one is treated with intrameduller nailing combined with two cerclage wires(Figure 2-3-5-6). The others are treated with hanging arm cast followed by a functional brace(Figure 1-4-7). The ages of the recruits varied from 20-28 years and the mean follow up period was 8 months, ranging from 0.5 and 13.5 months. Results No matter how poor the alignment was, a hanging cast was the treatment of first choice , in five cases bony union was obtained in 8-15 weeks, function was evaluated with respect to range of motion of the shoulder and elbow. According to these criteria, good function was obtained in all of five patients. In the patients with radial nerve involvement,
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