Humerus shaft fracture: Difference between revisions
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{{Adult top}} [[humerus shaft fracture (peds)]] | |||
==Background== | ==Background== | ||
*Shaft defined as middle one-third of humerous from lesser tubercle to supracondylar ridges | |||
*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 ( | |||
==Clinical Features== | ==Clinical Features== | ||
*Frequently occurs via direct blow, fall, or FOOSH | |||
*Localized tenderness, swelling, pain | *Localized tenderness, swelling, pain | ||
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{{Shoulder DDX}} | {{Shoulder DDX}} | ||
== | ==Evaluation== | ||
* | ===Workup=== | ||
*AP and lateral views of humerus | |||
*Consider additional views of elbow and shoulder | |||
===Diagnosis=== | |||
*Rule-out [[radial nerve injury]] (wrist drop - no extension of wrist, fingers, or thumb) | |||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
{{Humerus shaft fracture splint}} | |||
==Disposition== | |||
*Outpatient ortho referral (if adequate pain control) | |||
===Subspecialty Orthopedic Care=== | |||
'''Non Operative''' | '''Non Operative''' | ||
*Most do not need surgery if | *Most do not need surgery if | ||
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*Neurovascular injury | *Neurovascular injury | ||
*Significant soft tissue injury | *Significant soft tissue injury | ||
*Open | *Open fracture | ||
*Concern for compartment syndrome | *Concern for compartment syndrome | ||
*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/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 22:11, 13 June 2020
This page is for adult patients. For pediatric patients, see: humerus shaft fracture (peds)
Background
- Shaft defined as middle one-third of humerous from lesser tubercle to supracondylar ridges
- 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, fall, 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
- AP and lateral views of humerus
- Consider additional views of 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)