Humerus shaft fracture: Difference between revisions
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===Specific Management=== | ===Specific Management=== | ||
'''Treatment in the ED for either''' | |||
{{Humerus shaft fracture splint}} | |||
==Disposition== | |||
*Outpatient ortho referral (if adequate pain control) | |||
==Sub-speciality Care=== | |||
'''Non Operative''' | '''Non Operative''' | ||
*Most do not need surgery if | *Most do not need surgery if | ||
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*Floating elbow (ipsilateral forearm fracture) | *Floating elbow (ipsilateral forearm fracture) | ||
*Neurovascular injury (radial nerve injury not contraindication to splinting) | *Neurovascular injury (radial nerve injury not contraindication to splinting) | ||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 06:47, 18 September 2019
Background
- Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
- Occurs via direct blow or FOOSH
- Common site of pathologic fractures (esp breast cancer)
- Rule-out radial nerve injury (wrist drop - no ext of wrist, fingers, or thumb)
Clinical Features
- Localized tenderness, swelling, pain
Differential Diagnosis
Humerus Fracture Types
Shoulder and Upper Arm Diagnoses
Traumatic/Acute:
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
Nontraumatic/Chronic:
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
- Cervical radiculopathy
Refered pain & non-orthopedic causes:
- Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pneumonia
- Pulmonary embolism
Evaluation
- Obtain views of humerus, elbow and shoulder
Management
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
Specific Management
Treatment in the ED for either
- U-shaped coaptation splint (upper arm sugar-tong splint) + sling and swathe
Disposition
- Outpatient ortho referral (if adequate pain control)
Sub-speciality Care=
Non Operative
- Most do not need surgery if
- Less than 20% anterior angulation
- 30% varus/valgus angulation
- < 3cm shortening
Operative
- Neurovascular injury
- Significant soft tissue injury
- Open fracture
- Concern for compartment syndrome
- Floating elbow (ipsilateral forearm fracture)
- Neurovascular injury (radial nerve injury not contraindication to splinting)