Humerus shaft fracture: Difference between revisions
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==Background== | ==Background== | ||
*Peaks in third and seventh decades of life (young men and osteoporotic elderly women) | *Peaks in third and seventh decades of life (young men and osteoporotic elderly women) | ||
*Common site of pathologic fractures (especially breast cancer) | *Common site of pathologic fractures (especially breast cancer) | ||
==Clinical Features== | ==Clinical Features== | ||
*Frequently occurs via direct blow or FOOSH | |||
*Localized tenderness, swelling, pain | *Localized tenderness, swelling, pain | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*Obtain views of humerus, elbow and shoulder | *Obtain views of humerus, elbow and shoulder | ||
===Diagnosis== | |||
*Rule-out [[radial nerve injury]] (wrist drop - no extension of wrist, fingers, or thumb) | |||
==Management== | ==Management== | ||
Revision as of 06:53, 18 September 2019
Background
- Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
- Common site of pathologic fractures (especially breast cancer)
Clinical Features
- Frequently occurs via direct blow or FOOSH
- 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
Workup
- Obtain views of humerus, elbow and shoulder
=Diagnosis
- Rule-out radial nerve injury (wrist drop - no extension of wrist, fingers, or thumb)
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
- U-shaped coaptation splint (upper arm sugar-tong splint) + sling and swathe
Disposition
- Outpatient ortho referral (if adequate pain control)
Subspecialty Orthopedic 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)