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: @@
-==Proximal Fracture==
+{{Adult top}} [[Humerus fracture (peds)]].''
-===Background===
+==Background==
-*Typically occur in elderly osteoporotic pts from FOOSH mechanism
+[[File:Communitive midshaft humeral fracture callus.jpg|thumb|Comminuted midshaft humeral fracture with callous formation]]
-*Must rule-out axillary and brachial plexus neurovascular injuries
+{{Proximal arm fracture DDX}}
-*Greater tuberosity fx suggests rotator cuff tear
-*Lesser tuberosity fx suggests posterior shoulder dislocation
-===Clinical Features===
+==Clinical Features==
-*Pain, swelling, tenderness about the shoulder
+*History of trauma
-*Arm is held closely against chest wall
+*Pain over fracture site
-===Imaging===
+==Differential Diagnosis==
-*AP, lateral, and axillary radiographs
+{{Shoulder DDX}}
-*Fx of articular surface suggested by pseudosubluxation:
-***Superior joint hematoma pushes humerus down
-===Management===
+==Evaluation==
-*Guided by the Neer System
+===Workup===
-**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" fx is one in which fragment is displaced <1cm or not angulated >45deg
-*"One-part" fracture:
-**Sling and swathe, ice, ortho referral
-*More than one-part fractures:
-**Ortho consult in the ED
-==Shaft Fracture==
+===Diagnosis===
-===Background===
-*Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
-*Occurs viaa direct blow or FOOSH
-*Common site of pathologic fractures (esp breast cancer)
-*Rule-out radial nerve injury
-===Clinical Features===
+==Management & Disposition==
-*Localized tenderness, swelling, pain
+{{General Fracture Management}}
-===Imaging===
+{{Adult Humerus Fracture Management Table}}
-*Obtain views of humerus, elbow and shoulder
-===Management===
+==See Also==
-*Ice, sling and swathe, ortho referral
+*[[Fractures (main)]]
+*[[Splinting]]
-==See Also==
+==External Links==
-*[[Humerus Fracture (Peds)]]
-*[[Fracture (Main)]]
-==Source==
+==References==
-*Tintinalli
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]