Medical Minute Recap: Humeral Shaft Fractures
Leave a commentSeptember 22, 2015 by dailybolusoflr
By: Karolina Paziana, MD
Location determines deformity:
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- Fx proximal to pectoralis major insertion: proximal fragment will be abducted and externally rotated due to unopposed rotator cuff action – DIFFICULT TO REDUCE
- Fx proximal to deltoid but distal to pec insertion: Pull fragments in opposite directions
- Fx distal to deltoid insertion: proximal fragment is abducted by deltoid, distal fragment shortens due to biceps and triceps contraction.
- Holstein Lewis Fx: distal 1/3 of humerus, where radial nerve spirals posteriorly. High incidence of radial nerve palsy.
Neurovascular Concerns:
- Most common nerve injury – RADIAL NERVE (10-18% of humeral shaft fx)
- Most common nerve deficits: inability to extend the thumb or wrist + decreased sensation over hand dorsum
- Neurological Exam:
- Median & Ulnar nerve motor and sensory
- Triceps function (will not displace fx)
- Hitchhiker sign
- Wrist extension
- Sensation of the hand (dorsum – thenar web space)
Management:
Emergency Surgery: Open Fractures, Compartment Syndrome, Vascular Injury
Admission for Surgery
- Floating Elbow
- Segmental Fractures
- Displaced intra-articular fx
- Bilateral humeral fractures
- Progressive neurologic injury
- Post-rdx neurovascular injury
- Pathologic fxs
- Inability to reduce
Delayed Surgical Management (after DC home):
- Poor pain tolerance
- Inability to perform ADLs
- Delayed nerve palsy
- Non-union
- Delayed Union
- Loss of reduction
Ortho Consult: Displaced/angulated fractures, nerve palsy
Reduction: Rotational deformity, >30 degrees varus angulation or >2cm shortening.
Discharge Planning: Ortho f/u w/in 1 week, pain control, immobilization. REASSURANCE.
Reference:
Courtney C. Nothing Humorous About This Fracture. Emergency Physician Monthly July 2015 Vol 22:7. http://epmonthly.com/article/nothing-humorous-about-this-fracture/ Accessed July 4, 2015.
