[Reprinted from the Boston Medical and Surgical Journal 
of January 9, 1896.] 
ANOTHER CASE OF FRACTURE OF THE 
HUMERUS FROM AN UNUSUAL CAUSEJ 
A Spiral Fracture from Torsion. 
GEORGE H. MONKS, M.D. 
In the “ Boston City Hospital Medical and Surgical 
Reports ” for 1895,21 gave at length the history of the 
case of a man who had fractured his right humerus 
while engaged in that test of strength in which two ad- 
versaries sitting opposite to each other at a table, grasp 
each other’s hands, and, while the elbows rest upon the 
table, each tries to push his opponent’s hand down. 
The case did not present any peculiarities except that 
the cause was an unusual one, and it was for this rea- 
son that I reported it. The fracture had evidently 
been due to extreme torsion of the shaft of the humerus. 
Judging from the scanty literature on the subject, 
fractures of the humerus from this cause must be 
extremely rare. I was therefore much surprised, as 
well as interested, to have called to my attention re- 
cently a second case of fractured humerus from the 
same cause. The man, a bar-tender, twenty-four years 
1 Head before the Surgical Section of the Suffolk District Medical 
Society, November 6, 1895. 
2 Also reported in Boston Medical and Surgical Journal, March 21, 
1895. 2 
old, was engaged with a friend in the above-described 
sport, when the right humerus broke near the middle 
of the shaft. For this injury he was admitted to the 
Boston City Hospital on the same day (September 11th). 
Soon after he entered the hospital, delirium tremens 
developed, and later pneumonia; and the patient died 
on September 19th, eight days after the accident. Dr* 
M. F. Gavin, to whose service the man had been as- 
signed on entering the hospital, kindly allows me to 
publish this case. An autopsy was performed soon 
after death, and I was asked to make an examination 
of the injured bone. An incision was made on the outer 
side of the arm from the shoulder to the elbow and 
reaching down to the bone. In the vicinity of the 
fracture much extravasated blood was found, and some 
of the muscles were lacerated. Apparently none of 
the vessels or nerves were injured. The bone itself 
was removed entire. It was cleaned, and then boiled 
for about forty-eight hours, after which it was dried 
and carefully examined. The bone was apparently of 
average size and strength. There was a fracture at 
the junction of the lower and middle thirds. The 
accident had broken the bone into three pieces, the 
upper piece constituting about three-fifths of the entire 
length of the bone ; the lower piece, the remaining two 
fifths; the third piece being a vertical splinter about 
three inches long from the inner aspect of the bone. 
When these three fragments were placed together they 
fitted accurately. The principal line of fracture was a 
spiral one. The drawing shows this spiral line of Fig. 1. 
Fig. 2. 
Fig. 3. 
Fig. 4. 3 
fracture (indicated by an unbroken black line) on the 
four aspects of the bone. 
This line commenced above on the inner aspect of 
the bone (Fig. 1) and crossed around the back of the 
bone (Fig. 2) obliquely downwards and outwards; 
and, still pursuing the same spiral course around the 
outer side (Fig. 3) and front (Fig. 4), it finally re- 
turned to the inner aspect of the bone (Fig. 1), 
where it ended at a point about three and a half 
inches below where it started. Thus a complete 
spiral was made about the bone. This spiral was com- 
plicated by two other lines of fracture on the inner as- 
pect of the bone which were vertical and close together, 
and which completed the separation of the small frag- 
ment already referred to. The vertical sides of this 
fragment are indicated in the figures by the dotted 
lines. 
The case seems to be interesting not only on account 
of the unusual cause, but also because of the spiral 
nature of the fracture, such a fracture being just what 
would be expected from a severe twist (torsion) of the 
bone. 
The first case of fracture, to which I have referred, 
I considered, at the time of examination, to be a trans- 
verse fracture; but this was after a clinical examination 
only, and at that time I did not have in mind the prob- 
ability that a fracture which followed torsion of the 
bone, would be spiral in character. Dr. F. B. Lund 
has kindly called my attention to the fact that several 
cases of fracture of the humerus have been reported 4 
during the attempt by Kocher’s method of torsion to 
reduce old dislocations of the shoulder, and that the 
forces at work during this procedure are analogous to 
those employed in the sport to which I have referred; 
for while the lower end of the bone is strongly rotated 
outwards, the upper end is either rotated inwards by 
the muscles, or resists the outward rotation. It would 
be interesting to know whether fractures which have 
occurred during the use of Kocher’s method, were, 
what might be called “ spiral ” or not.