Humerus fracture: Difference between revisions

Revision as of 03:31, 11 February 2012

Proximal Humerus Fracture

Background

Typically occur in elderly osteoporotic pts from FOOSH mechanism
Must rule-out axillary and brachial plexus neurovascular injuries
Greater tuberosity fx suggests rotator cuff tear
Lesser tuberosity fx suggests posterior shoulder dislocation

Clinical Features

Pain, swelling, tenderness about the shoulder
Arm is held closely against chest wall

Imaging

AP, lateral, and axillary radiographs
Fx of articular surface suggested by pseudosubluxation:
- - Superior joint hematoma pushes humerus down

Management

Guided by the Neer System
- 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
>One-part fractures
- Ortho consult in the ED

Humerus Shaft Fracture

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
-==Diagnosis==
+==Proximal Humerus Fracture==
-X-ray
+===Background===
+*Typically occur in elderly osteoporotic pts from FOOSH mechanism
+*Must rule-out axillary and brachial plexus neurovascular injuries
+*Greater tuberosity fx suggests rotator cuff tear
+*Lesser tuberosity fx suggests posterior shoulder dislocation
-==Work-Up==
+===Clinical Features===
-#skin inspection (r/o open fx)
+*Pain, swelling, tenderness about the shoulder
-#neurovascular function
+*Arm is held closely against chest wall
-#Flat films
-##shoulder x-ray with at least one view (axillary or scapular-Y) to r/o humeral head dislocation
-==Treatment==
+===Imaging===
-# Open --> to OR
+*AP, lateral, and axillary radiographs
-#Neurovascular dysfx --> ortho
+*Fx of articular surface suggested by pseudosubluxation:
-# Closed, DNVI
+***Superior joint hematoma pushes humerus down
-##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==
+===Management===
-Outpt Except
+*Guided by the Neer System
-# Open fx
+**Proximal humerus is divided into four "parts" based on epiphyseal lines:
-# NVascular injuries
+***Articular surface of humeral head
-#Consider:
+***Greater tubercle
-## Articular injuries
+***Lesser tubercle
-##Ipsilateral forearm fractures (floating elbow injuries)
+***Shaft of humerus
-##Pathologic fractures
+**A "one-part" fx is one in which fragment is displaced <1cm or not angulated >45deg
-##Concomitant traumatic fractures
+*"One-part" fracture
-## Distal spiral shaft fractures (Holstein Lewis fractures) - high association with radial nerve injuries (consider surgical exploration and repair)
+**Sling and swathe, ice, ortho referral
+*>One-part fractures
+**Ortho consult in the ED
-==Complications ==
+==Humerus Shaft Fracture==
-#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
+*Tintinalli
 [[Category:Ortho]]