What are the general characteristics for a humeral head fracture?
Most occur in older pts w/ osteoporosis
F:M = 2:1
What are the sxs of humeral head fracture?
- Pain, swelling, tenderness esp. in region of greater tuberosity
- Pt holds affected extremity against chest wall
- Look for injuries to brachial plexus and/or axillary nerve/artery
Where is the most common area for a humeral fx?
surgical neck fracture of humerus
What imaging studies are used for a humeral head frx?
AP, lateral and “Y” view (outlet view), axillary
What is the tx for a humeral head fx?
- Sling for most nondisplaced fxs (check axillary nerve)
A. Early mobilization w/ pendulum exercises to prevent frozen shoulder - Refer to Ortho for ORIF -> displaced fxs
What is the best true lateral view of the shoulder?
- Axillary view
A. Superior to inferior or inferior to superior
What is pendulum exercises?
The arm is hung downward and rotated in large circles in order to regain shoulder range of motion
What is the MOI of a humeral shaft fx?
- MVA
- Fall on outstretched hand
- Penetrating injuries, i.e. gunshot wound
What are the sxs of a humeral shaft fx?
- Pain, swelling, deformity and arm shortening
2. Radial nerve must be assessed for possible injury, as well as ulnar nerve and median nerve
What nerve does the thumbs up sign test?
Wrist extension also for
radial nerve function
What imaging is used for humeral shaft fx?
Xray: AP & Lateral views of shoulder & elbow
What is the tx for humeral shaft fx?
- Specialized splints: long arm splint/proximal sugar tong splint/coaptation splint/clamshell brace
- Operative repair: ORIF
A. Displaced fracture
B. Neurovascular compromise
What are the complications of humeral shaft fx?
- Radial nerve injury: 18% of cases
A. Occurs @ time of frx
B. May also develop after reduction
C. Delayed complication as a result of incorporation of nerve by callus formation (healing bone)
What is the MOI for a supracondylar fx?
Fall on outstretched hand
What are the sxs of a supracondylar fx?
Gross swelling and tenderness proximal to elbow
What neurovascular injury may occur for a supracondylar fx?
- Radial artery, Brachial artery
2. Median, Radial & Ulnar nerves
When and where does vascular injury occur in a supracondylar fx?
*vascular injury occurs in 5-20% of children w/ supracondylar frx (brachial artery injured)
Most nerve palsies from supracondylar frx are neuropraxias, and will resolve spontaneously
Median nerve can be up to 50%
Radial nerve can be up to 25%
What does the OK sign test?
Median nerve integrity
How is ulnar nerve integrity tested?
Hold a piece of paper between fingers
What imaging is used for supracondylar fx?
- AP & lateral views (include elbow and wrist)
A . 5-6% can have distal radius frx too - In children, always bilateral views to compare
What is the tx for a supracondylar fx?
- Long arm cast for children w/ nondisplaced fx
- Closed reduction in OR w/ post. splint application for displaced fxs (post reduction x-rays and neurovascular checks)
- Adults should always have ORIF
What are potential complications of supracondylar fx?
- Compartment syndrome (< 1%) and the resulting sequelae of Volkmann’s contractures
A. Injuries to Brachial artery and Median nerve (and radial nerve) - Varus or valgus deformities of elbow
What is volkmann’s contracture?
- Type of forearm ischemic contracture from injury to brachial artery asst w/ supracondylar fx
What happens? - Fixed flexion of the elbow, pronation of the forearm, flexion at the wrist, and joint extension of the metacarpal-phalangeal joint
What is the most common elbow fx in adults?
Radial head/neck fx?
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Bone Phys56
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Osteoporosis39
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Arthritis85
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Autoimmmune dx75
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Bone and Joint Disorders55
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Median and Ulnar Nerve Entrapment20
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Shoulder Injuries40
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Overview of Fractures30
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Fractures 129
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Fractures 238
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Disorders of the Spine95
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Bone neoplasms59
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Hip and Lower Extremity Disorders98
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ankle/foot pathologies76
