Humerus fracture

Diagnosis

X-ray ==Work-Up==

-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

Treatment

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

Disposition

Outpt Except

1) Open fx

2) NVascular injuries

Consider:

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

1) 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)

1) Nonunion (2-5%)

    -no union at 3-4 months

    -more common in transverse and severely comminuted fractures

Source

KajiQuestions

Authors: