Humerus fracture: Difference between revisions
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*Greater tuberosity fx suggests rotator cuff tear | *Greater tuberosity fx suggests rotator cuff tear | ||
*Lesser tuberosity fx suggests posterior shoulder dislocation | *Lesser tuberosity fx suggests posterior shoulder dislocation | ||
[[File:Prox humerus fracture.jpeg|thumbnail]] | |||
===Clinical Features=== | ===Clinical Features=== | ||
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*More than one-part fractures: | *More than one-part fractures: | ||
**Ortho consult in the ED | **Ortho consult in the ED | ||
==Shaft Fracture== | ==Shaft Fracture== | ||
Revision as of 19:20, 20 July 2013
Proximal Fracture
Background
- Typically occur in elderly osteoporotic pts from FOOSH mechanism
- Must rule-out axillary and brachial plexus neurovascular injuries
- Greater tuberosity fx suggests rotator cuff tear
- Lesser tuberosity fx suggests posterior shoulder dislocation
Clinical Features
- Pain, swelling, tenderness about the shoulder
- Arm is held closely against chest wall
Imaging
- AP, lateral, and axillary radiographs
- Fx of articular surface suggested by pseudosubluxation:
- Superior joint hematoma pushes humerus down
Management
- Guided by the Neer System
- Proximal humerus is divided into four "parts" based on epiphyseal lines:
- Articular surface of humeral head
- Greater tubercle
- Lesser tubercle
- Shaft of humerus
- A "one-part" fx is one in which fragment is displaced <1cm or not angulated >45deg
- Proximal humerus is divided into four "parts" based on epiphyseal lines:
- "One-part" fracture:
- Sling and swathe, ice, ortho referral
- More than one-part fractures:
- Ortho consult in the ED
Shaft Fracture
Background
- Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
- Occurs viaa direct blow or FOOSH
- Common site of pathologic fractures (esp breast cancer)
- Rule-out radial nerve injury
Clinical Features
- Localized tenderness, swelling, pain
Imaging
- Obtain views of humerus, elbow and shoulder
Management
- Ice, sling and swathe, ortho referral
See Also
Source
- Tintinalli