Fractures

Fractures Type of fracture Proximal Humeral Fracture Epidemiology Mechanism Radiological Findings Clinical Features Management Elderly Conservative Axillary nerve injury Non-displaced fractures Low energy trauma Most common Immobilise in an arm nerve injury sling Young people Arterial injury Collar and cuff sling Lucency Most common in older patients – High energy especially those trauma with osteoporosis Cortical breach Fall from a height or motor Most at home Various degrees accidents due to a fall of angulation Fall on an Most common Impaction type of proximal outreached arm humeral fracture Displacement Indirect forces transmitted to the prox. Humerus Most common May be masked by extensive collateral circulation Consult orthro urgently when there is fracture dislocation or displaced fracture segments Analgesia preserve distal pulses Pain Surgical management Swelling Open fractures Decreased range of motion Poor reduction Pathological fractures Neurovascular compromise Conservative management Surgical management Radial nerve Alignment cannot be injury maintained Peak in 3 rd Humeral Shaft Fracture Direct blow to the upper arm decade of life in Transverse males fracture Peake in 5 th Indirect trauma Fall or twisting fracture e.g. arm decade of life in wrestling females Esp with Holstein Open fractures Vascular injury Uneven distribution at humeral diaphysis Lews Segmental fracture Fracture Floating elbow Less common damage to Non-union brachial artery, median Pathological fracture and ulna nerves. In most cases radial nerve palsy is not an indication for exploration Most are managed surgically since prolonged immobilisation Leads to poor functional outcomes Pain The primary goal of surgical treatment is anatomical Swelling Functional disability Distal Humeral fracture Young males Elderly women Involve the epicondyles, trochlea capitellum and metaphysis of distal humerus Usually due to high energy trauma Decreased or abnormal pulses Weakness or paraesthesia Nerve injury Complications E.g. traffic road Neurovascular injury accidents Forearm compartment syndrome Osteoarthritis Plain x ray reconstruction of the articular surface and to gain stability to allow for early functional treatment for maintaining a ROM The gold standard is an Conservative elbow flexed management can be 40 degrees considered for Milch type 1 fracture Epicondylar fracture -> screw fixation Extra-articular fractures -> pre-contoured locking plates of the affected side Very comminute and non-reconstruct able fractures or patients with pre-exiting OA -> hemiarthroplasty or total elbow arthroplasty Proximal or Fall on outstretched and middle ulna pronated forearm fracture with a radial head (FOOSH) dislocation Low energy Pain Direct blow Crepitus High energy Reduced ROM Types: Radial head I: anterior radial palpable in the head dislocation antecubital fossa Monteggia Most commonly fracture in children Most common II: posterior radial head dislocation Shortened forearm Posterior interosseous nerve injury III: lateral or anterolateral Paraesthesia t radial dislocation dorsal aspect of the thumb, Anterior radial second and third head dislocation fingers + proximal third ulnae and radial Loss of thumb shaft fractures extension Children with uncomplicated fractures Closed reduction by orthopaedic surgeon Children and adults with complication fractures e.g. displaced Initial: immobilise in a posterior long arm splint Definitive: ORIF e.g. plating, K-wire fixation Radial shaft fracture with disruption of the distal radioulnar joint Pain and deformity at the distal radius Galeazzi Fracture Fall on More common in outstretched and pronated forearm Limited ROM older children MVC Children with uncomplication fractures Closed reduction by a an orthro surgeon followed by casting Adults and children with complicated fractures: Palpable displacement of the ulna head Initial: immobilise in a posterior long arm splint Rarely neurological injury Definitive: ORIF e.g. plating or K-wire fixation needed for most Arm shortening?