humeral shaft fracture Flashcards
what nerve is at risk of injury from a humeral shaft fracture?
the radial nerve within the spiral groove
what are the risk factors for humeral shaft fractures?
- oesteoporosis
- increasing age
- previous fractures
what are the clinical features of humeral shaft fractures?
pain and deformity
if radial nerve is involved, may be reduced sensation over dorsal 1st webspace and weakness in wrist extension
what should you check for in examination of a humeral shaft fracture?
check NV status
asses for open wounds
asses for any concurrent injuries/fractures
what is a Holstein Lewis fracture?
a fracture to the distal third of the humerus resulting in entrapment of the radial nerve
result is loss of sensation in the radial distribution and wrist drop deformity
surgical management is indicated in such cases
what investigations are done into humeral shaft fractures?
AP and lateral plain film radiographs of the humerus
in severely comminuted cases, CT may be requested for pre operatively planning, but this is not routinely done
what is the mainstay management for humeral shaft fractures?
re alignment of limb
treat conservatively in a functional humeral brace
regular follow up with repeated plain film imaging
most patients will go onto full union within 8-12 weeks
when does surgical management involve?
involves open reduction and internal fixation with a plate
permits return to work slightly quicker than in conservative management
when can intramedullary nailing be indicated?
in the presence of pathological fractures, polytrauma or severely osteoporotic bone
what are the complications of humeral fractures?
- non union
- mal union
- varus angulation (but this rarely causes functional limitations as shoulders wide ROM compensates)
- radial nerve injury (but most usually improve within 3 months without intervention)
where do the majority of humeral shaft fractures occour?
in the middle third of the humerus
