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Humerus (Proximal Humeral Fracture (Investigations (x-rays: AP, trans…
Humerus
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Humeral Shaft Fracture
Mechanism
high energy, FOOSH, metastases
Clinical Features
pain, swelling, weakness ± shortening
must test radial nerve function before and after treatment: look for drop wrist, sensory impairment dorsum of hand
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Treatment
Conservative treatment:
closed reduction, placed in a cast (Desaullt) or shoulder stabilizer
Olecranon skeletal traction
Hanging arm cast
operative:
indications: “NO CAST” , pathological fracture, “floating elbow”
ORIF: plating (most common), IM rod insertion, external fixation
Specific Complications
radial nerve palsy, non-union: most frequently seen in middle1/3, compartment syndrome
Distal Humeral Fracture
- Mechanism: high energy trauma, FOOSH
- Features: elbow pain and swelling,
- Investigations: x-ray: AP and lateral, CT scan
Classification
supracondylar, distal single column, distal bicolumnar and coronal shear fractures
Treatment
- goal is to re store ROM 30-130° flexion.
- non-operative: cast immobilisation
- operative:
indications: displaced, supracondylar, bicolumnar
closed reduction and percunatneous pinning; ORIF; total elbow arthroplasty (bicolumnar in elderly)