Humerus fracture

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