Humeral shaft fracture Flashcards
(20 cards)
How are humeral shaft fractures defined anatomically?
Fractures extending from below the surgical neck to the supracondylar ridge.
What are the common mechanisms of injury for humeral shaft fractures?
High energy impacts (falls from height, road accidents) or low energy impacts (fall from standing height or trivial trauma as in pathological fractures).
What approach should be used for clinical assessment of patients with high energy impact humeral shaft fractures?
The Advanced Trauma Life Support (ATLS) approach
Which nerve is most important to assess and document in humeral shaft fractures?
The radial nerve
What three elements should be assessed and documented in the initial examination of humeral shaft fractures?
1) Neurovascular status (especially the radial nerve),
2) Status of the soft tissue envelope,
3) ATLS assessment for high energy trauma patients
What is the initial conservative treatment for humeral shaft fractures?
U Slab for six weeks
What are the three criteria for acceptable position in conservative management of humeral shaft fractures?
1) More than 50% apposition
2) Less than 30° valgus or varus deformity
3) Less than 30° anterior or posterior angulation.
What should be done if acceptable position criteria cannot be achieved or maintained?
Proceed to surgical treatment of the fracture.
What are the four absolute indications for surgery in humeral shaft fractures?
1) Open fracture
2) Fracture with neurovascular injury requiring repair
3) Failure of conservative treatment, 4) Nonunion/malunion.
What are five relative indications for surgery in humeral shaft fractures?
1) Segmental fracture, 2) Pathological fracture, 3) Multiple fractures
4) Ipsilateral shoulder or forearm fracture,
5) Other forms of soft tissue compromise
6) Patient’s work or leisure requirements.
What are the four common complications of humeral shaft fractures?
1) Neurovascular injuries
2) Malunion
3) Nonunion
4) Joint stiffness.
What specific humeral shaft fracture is associated with high risk of radial nerve palsy?
Distal third spiral fracture (Holstein-Lewis fracture).
Why is the Holstein-Lewis fracture particularly concerning?
It has a high association with radial nerve palsy due to the anatomy of the radial nerve as it passes through the spiral groove in the distal third of the humerus.
A 45-year-old patient presents with a humeral shaft fracture after a fall. X-rays show 40% apposition and 35° varus angulation. What is the appropriate management?
Since the fracture does not meet the criteria for acceptable position (less than 50% apposition and more than 30° varus deformity), surgical treatment is indicated.
A patient presents with a closed humeral shaft fracture with complete radial nerve palsy. Initial X-rays show good alignment. What is the appropriate management approach?
Document the neurological deficit, initiate conservative treatment with a U Slab if the fracture position is acceptable, and arrange for close follow-up. If the nerve palsy was caused by the initial trauma, many surgeons would observe as most traumatic radial nerve palsies recover spontaneously. However, if there’s suspicion that the nerve is entrapped or was injured during reduction, surgical exploration may be warranted
A 70-year-old patient presents with a humeral shaft fracture after minimal trauma. What additional concern should be investigated?
The possibility of a pathological fracture due to underlying bone disease (like metastatic cancer, multiple myeloma, or severe osteoporosis) should be investigated, as fractures from minimal trauma in this age group are suspicious for pathological causes.
A patient with a humeral shaft fracture has been treated conservatively in a U Slab for 3 weeks. Follow-up X-rays show displacement with 25° posterior angulation and 55% apposition. What is your management plan?
Continue conservative management as the fracture position is still within acceptable parameters (less than 30° angulation and more than 50% apposition).
A 30-year-old construction worker presents with a mid-shaft humeral fracture with acceptable alignment. He is concerned about returning to work quickly. What factors might influence your treatment decision?
While conservative treatment with a U Slab would be the standard approach for a well-aligned fracture, the patient’s occupation as a construction worker might be considered a relative indication for surgical management based on “patient’s work requirements” to potentially allow earlier return to function.
Describe the proper application technique for a U Slab in humeral shaft fractures.
- Position the patient’s elbow at 90° flexion
- Apply appropriate padding over bony prominences
- Prepare plaster slabs that extend from the axilla, around the elbow, to the hand
- Apply the wet plaster to the medial and lateral aspects of the arm, forming a U shape
- Hold the fracture in proper alignment while the plaster sets
- Secure the slab with bandages
- Keep the wrist free if possible
- Support the arm in a sling
- Ensure the slab is not circumferential to avoid compartment syndrome
- Check distal neurovascular status after application
how to test for radial nerve function ?
Motor function: Test wrist extension, finger extension (especially the metacarpophalangeal joints), and thumb extension/abduction
Sensory function: Check sensation over the dorsal web space between the thumb and index finger (the autonomous zone of the radial nerve)
Document any deficits precisely, indicating which specific movements are affected and to what degree
