Humerus fracture: Difference between revisions

Revision as of 07:00, 18 September 2019

Types

Humerus Fracture Types

Humeral anatomy

Adult
- Proximal
- Shaft
- Distal
Pediatric
- Proximal
- Shaft
- Distal

Comminuted midshaft humeral fracture with callous formation

Differential Diagnosis

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Referred pain from
- Neck
- Diaphragm (e.g. gallbladder disease)
Brachial plexus injury
- Rucksack paralysis
Axillary artery thrombosis
Thoracic outlet syndrome
Subclavian steal syndrome
Pancoast tumor
Myocardial infarction
Pneumonia
Pulmonary embolism

Management & Disposition

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

See specific fracture type

References

Authors:

@@ Line 1: / Line 1: @@
-==[[Proximal humerous fracture]]==
+==Types==
-===Background===
+{{Proximal arm fracture DDX}}
-*Typically occur in elderly osteoporotic pts from FOOSH mechanism
-*Must rule-out axillary and brachial plexus neurovascular injuries
-*Greater tuberosity fx suggests rotator cuff tear
-*Lesser tuberosity fx suggests posterior shoulder dislocation
-[[File:Prox humerus fracture.jpeg|thumbnail]]
-===Clinical Features===
+[[File:Communitive midshaft humeral fracture callus.jpg|thumb|Comminuted midshaft humeral fracture with callous formation]]
-*Pain, swelling, tenderness about the shoulder
-*Arm is held closely against chest wall
-===Imaging===
-*AP, lateral, and axillary radiographs
-*Fx of articular surface suggested by pseudosubluxation:
-***Superior joint hematoma pushes humerus down
 ==Differential Diagnosis==
-{{Proximal arm fracture DDX}}
+{{Shoulder DDX}}
-===Management===
-*Guided by the Neer System
-**Proximal humerus is divided into four "parts" based on epiphyseal lines:
-***Articular surface of humeral head
-***Greater tubercle
-***Lesser tubercle
-***Shaft of humerus
-**A "one-part" fx is one in which fragment is displaced <1cm or not angulated >45deg
-*"One-part" fracture:
-**Sling and swathe, ice, ortho referral
-*More than one-part fractures:
-**Ortho consult in the ED
-==[[Humerus shaft fracture]]==
-===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===
+==Management & Disposition==
-*Localized tenderness, swelling, pain
+{{General Fracture Management}}
-===Imaging===
-*Obtain views of humerus, elbow and shoulder
-==Differential Diagnosis==
-{{Proximal arm fracture DDX}}
-===Management===
+===Specific===
-*Ice, sling and swathe, ortho referral
+See specific fracture type
 ==See Also==
-*[[Humerus Fracture (Peds)]]
+*[[Fractures (main)]]
-*[[Fracture (Main)]]
-==Source==
+==References==
-*Tintinalli
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]