Proximal humerus fracture: Difference between revisions
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==Management== | ==Management== | ||
Non Operative | |||
*85% Non-op, often with following features | |||
**Minimally displaced | |||
**Greater tubercle < 5mm displaced | |||
**Consider in advanced age, poor bone quality, non dominant hand, co-morbid disease, other injuries | |||
*"One-part" fracture: | *"One-part" fracture: | ||
**[[Sling and swathe splint]], ice, ortho referral | **[[Sling and swathe splint]], or coaptation splint, ice, ortho referral | ||
*More than one-part fractures: | *More than one-part fractures: | ||
**Ortho consult in the ED | **Ortho consult in the ED | ||
Revision as of 23:05, 25 May 2016
Background
- Typically occur in elderly osteoporotic patients from FOOSH mechanism
- Must rule-out axillary and brachial plexus neurovascular injuries
- 45% have nerve injury (axillary most common)
- Greater tuberosity fracture suggests rotator cuff tear
- Lesser tuberosity fracture suggests posterior shoulder dislocation
Clinical Features
- Pain, swelling, tenderness about the shoulder
- Arm is held closely against chest wall
Differential Diagnosis
Humerus Fracture Types
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Diagnosis
- AP, lateral, and axillary radiographs
- Fracture of articular surface suggested by pseudosubluxation:
- Superior joint hematoma pushes humerus down
- Consider CT for
- Preop surgical planning
- Greater tuberosity or humoral head position uncertain
- Intra-articular comminution
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" fracture is one in which fragment is displaced <1cm or not angulated >45deg
Management
Non Operative
- 85% Non-op, often with following features
- Minimally displaced
- Greater tubercle < 5mm displaced
- Consider in advanced age, poor bone quality, non dominant hand, co-morbid disease, other injuries
- "One-part" fracture:
- Sling and swathe splint, or coaptation splint, ice, ortho referral
- More than one-part fractures:
- Ortho consult in the ED