Humerus shaft fracture

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Background

  • Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
  • Occurs via direct blow or FOOSH
  • Common site of pathologic fractures (esp breast cancer)
  • Rule-out radial nerve injury (wrist drop - no ext of wrist, fingers, or thumb)

Clinical Features

  • Localized tenderness, swelling, pain

Differential Diagnosis

Humerus Fractures

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Humeral anatomy

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Evaluation

  • Obtain views of humerus, elbow and shoulder

Management

Non Operative

  • Most do not need surgery if
    • Less than 20% anterior angulation
    • 30% varus/valgus angulation
    • < 3cm shortening

Operative

  • Neurovascular injury
  • Significant soft tissue injury
  • Open fracture
  • Concern for compartment syndrome
  • Floating elbow (ipsilateral forearm fracture)
  • Neurovascular injury (radial nerve injury not contraindication to splinting)

Treatment in the ED for either

References

  • Orthobullets

Disposition

  • Outpatient ortho referral (if adequate pain control)

See Also

References