Arm Fractures Flashcards
proximal humerus fractures
- who is it common in
- displacement
- which structures are often injured
common low energy in osteoperotic bone due to fall onto outstretched hand/directly onto shoulder
most commonly fracture of surgical neck (rather than anatomic neck) with medial displacement of the shaft due to the pull of the pec major muscle
brachial plexus and axillary artery are at risk of injury
where is the anatomical and surgical neck of the humerus
treatment of proximal humerus fractures
minimally displaced - conservatively in a sling
displaced - wait for muscle spasm to resolve, position might improve
persistently displaced - internal fixation, but stiffness, chronic pain and failure of fixation are common
humeral shaft fractures
caused by direct trauma resulting in transverse/comminuted fractures
or by fall with/out twisting injury - obique/spiral fractures
high union rates and due to mobility of joint significant (up to 30º) angulation can be tolerated without loss of function
what nerve is often damaged in humeral shaft fractures
- how does this manifest
radial nerve that runs in radial groove
manifests as wrist drop ( supplies posterior extensor muscles) and loss of sensation in first dorsal web space
treatment of humeral shaft fracture
most non-operative with a brace that compresses the fragments into alignment
internal fixation with IM nail or screw may afford quicker recovery
distal humeral fractures
usually intra articular and so require ORIF
olecranon fracture
- treatment
usually avulsion - fall onto elbow with triceps contraction
treat with ORIF
what are the attachments of the triceps muscle
proximal:
long head - infraglenoid tubercule of scapula
superior (lateral head) and inferior (medial head) to radial groove of humerus
distal:
all 3 heads combine to form triceps tendon, which attaches to olecranon process of the ulna
who are supracondylar fractures common in
most common type of elbow fracture in children
what are the two structures commonly injured in supracondylar fractures
median nerve and brachial artery
what is often damaged in a medial epicondyle fracture
ulnar nerve
radial head fractures
- fall onto outstretched arm
- OE; marked local tenderness over head of radius, impaired elbow movements and sharp pain at lateral side of elbow at extremes of rotation
- undisplaced/minimally displaced treated conservatively with sling
- often patients lose 10-15º extension
- ORIF if fragment large enough or block to extension
x ray signs of radial head fracture
- pathological posterior fat pad sign
why is the forearm unlikely to only break in one place
acts as a ring
nightstick fracture
- manage
- rule out?
isolated ulnar fracture occurs after direct blow
manage conservatively
rule out Monteggia
nightstick fracture