Humerus fracture: Difference between revisions

Latest revision as of 18:54, 22 March 2023

This page is for adult patients. For pediatric patients, see: Humerus fracture (peds).

Background

Comminuted midshaft humeral fracture with callous formation

Humerus Fracture Types

Humeral anatomy

Adult
- Proximal
- Shaft
- Distal
Pediatric
- Proximal
- Shaft
- Distal

Clinical Features

History of trauma
Pain over fracture site

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
Brachial plexus injury
- Rucksack paralysis
Axillary artery thrombosis
Thoracic outlet syndrome
Subclavian steal syndrome
Pancoast tumor
Myocardial infarction
Pneumonia
Pulmonary embolism

Evaluation

Workup

Diagnosis

Management & Disposition

General Fracture Management

Acute pain management
Open fractures require immediate IV antibiotics and urgent surgical washout
Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
Consider risk for compartment syndrome

Adult Humerus Fracture Management Table

Fracture	Splint	Disposition
Proximal	Sling and swathe splint, or coaptation splint	Non-emergent, but many need surgery, refer to ortho vs ED consult
Shaft	U-shaped coaptation splint (upper arm sugar-tong splint) + sling and swathe	R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Elbow Fracture (Adult)	Long arm posterior splint	R/o neurovasc injury and compartment syndrome, but many need surgery, refer to ortho vs ED consult
Olecranon	Nondisplaced: Sling and Swathe Splint Displaced: Long Arm Posterior Splint or emerg. ORIF	R/o neurovasc injury and compartment syndrome, refer to ortho within 24 hrs

External Links

References

Authors:

@@ Line 1: / Line 1: @@
-==Diagnosis==
+{{Adult top}} [[Humerus fracture (peds)]].''
+==Background==
+[[File:Communitive midshaft humeral fracture callus.jpg|thumb|Comminuted midshaft humeral fracture with callous formation]]
+{{Proximal arm fracture DDX}}
+==Clinical Features==
+*History of trauma
+*Pain over fracture site
-X-ray ==Work-Up==
+==Differential Diagnosis==
+{{Shoulder DDX}}
+==Evaluation==
+===Workup===
--skin inspection (r/o open fx)-neurovascular function-Flat films     -shoulder x-ray with at least one view (axillary or scapular-Y) to r/o humeral head dislocation
+===Diagnosis===
-==Treatment==
+==Management & Disposition==
+{{General Fracture Management}}
+{{Adult Humerus Fracture Management Table}}
-) Open --> to OR2) Neurovascular dysfx --> ortho3) Closed, DNVI     - Coaptation (sugar-tong) splint & outpt f/u     -(oblique or spiral fractures requiring traction, a collar and cuff sling is used instead)     - 70-80% closed treated without surgical intervention
+==See Also==
+*[[Fractures (main)]]
+*[[Splinting]]
-==Disposition==
+==External Links==
+==References==
+<references/>
-Outpt Except
+[[Category:Orthopedics]]
-) Open fx
-) NVascular injuries
-Consider:
-) Arrticular injuries
-)  Ipsilateral forearm fractures (floating elbow injuries)
-)  Pathologic fractures
-)  Concomitant traumatic fractures
-) Distal spiral shaft fractures (Holstein Lewis fractures) - high association with radial nerve injuries (consider surgical exploration and repair)
-==Complications ==
-) radial nerve injury
-     -10-18% of midshaft; more common in distal
-     -75-90% temporary neurapraxias (resolve 3-4 mo; all should be seen by ortho)
-)  Nonunion (2-5%)
-     -no union at 3-4 months
-     -more common in transverse and severely comminuted fractures
-==Source==
-KajiQuestions
-[[Category:Ortho]]