Humerus fracture: Difference between revisions

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==Diagnosis==
==Diagnosis==
X-ray


 
==Work-Up==
X-ray ==Work-Up==
#skin inspection (r/o open fx)
 
#neurovascular function
 
#Flat films
-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  
##shoulder x-ray with at least one view (axillary or scapular-Y) to r/o humeral head dislocation  


==Treatment==
==Treatment==
 
# Open --> to OR
 
#Neurovascular dysfx --> ortho
1) 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  
# 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  


==Disposition==
==Disposition==
Outpt Except
Outpt Except
 
# Open fx
1) Open fx
# NVascular injuries
 
#Consider:
2) NVascular injuries
## Articular injuries
 
##Ipsilateral forearm fractures (floating elbow injuries)
##Pathologic fractures
 
##Concomitant traumatic fractures
Consider:
## Distal spiral shaft fractures (Holstein Lewis fractures) - high association with radial nerve injuries (consider surgical exploration and repair)
 
1) Arrticular injuries
 
2)  Ipsilateral forearm fractures (floating elbow injuries)
 
3)  Pathologic fractures
 
4)  Concomitant traumatic fractures
 
5) Distal spiral shaft fractures (Holstein Lewis fractures) - high association with radial nerve injuries (consider surgical exploration and repair)
 


==Complications ==
==Complications ==
 
#radial nerve injury
 
##10-18% of midshaft; more common in distal
1) radial nerve injury
##75-90% temporary neurapraxias (resolve 3-4 mo; all should be seen by ortho)
 
#Nonunion (2-5%)
    -10-18% of midshaft; more common in distal
##no union at 3-4 months  
 
##more common in transverse and severely comminuted fractures
    -75-90% temporary neurapraxias (resolve 3-4 mo; all should be seen by ortho)
 
1)  Nonunion (2-5%)
 
    -no union at 3-4 months  
 
    -more common in transverse and severely comminuted fractures
 


==Source==
==Source==
KajiQuestions
KajiQuestions


[[Category:Ortho]]
[[Category:Ortho]]

Revision as of 22:16, 8 April 2011

Diagnosis

X-ray

Work-Up

  1. skin inspection (r/o open fx)
  2. neurovascular function
  3. Flat films
    1. shoulder x-ray with at least one view (axillary or scapular-Y) to r/o humeral head dislocation

Treatment

  1. Open --> to OR
  2. Neurovascular dysfx --> ortho
  3. Closed, DNVI
    1. Coaptation (sugar-tong) splint & outpt f/u
    2. (oblique or spiral fractures requiring traction, a collar and cuff sling is used instead)
    3. 70-80% closed treated without surgical intervention

Disposition

Outpt Except

  1. Open fx
  2. NVascular injuries
  3. Consider:
    1. Articular injuries
    2. Ipsilateral forearm fractures (floating elbow injuries)
    3. Pathologic fractures
    4. Concomitant traumatic fractures
    5. Distal spiral shaft fractures (Holstein Lewis fractures) - high association with radial nerve injuries (consider surgical exploration and repair)

Complications

  1. radial nerve injury
    1. 10-18% of midshaft; more common in distal
    2. 75-90% temporary neurapraxias (resolve 3-4 mo; all should be seen by ortho)
  2. Nonunion (2-5%)
    1. no union at 3-4 months
    2. more common in transverse and severely comminuted fractures

Source

KajiQuestions

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