Humeral Fracture Flashcards
Epidemiology and mechanism of injury of Humeral Shaft Fractures (HSF).
Occur in both younger patient in high energy trauma as well as elderly with low impact injuries.
This is called a bimodal distribution.
The fracture might occur from falling directly onto the outstretched limb, or falling laterally onto and adducted limb.
Common complication of HSF.
Due to location of radial nerve within the spiral groove there is a high risk of injury.
Overall incidence is around 10%
25% risk in Holstein-Lewis fractures.
Risk factors of HSF
Osteoporosis
Increasing age
Previous fractures
Pathology
Clinical features of HSF.
Pain and deformity
The fracture might occur from falling directly onto the outstretched limb, or falling laterally onto and adducted limb.
Weakness of wrist extension (radial nerve)
Reduced sensation over the dorsal 1s webspace (radial nerve)
Examination of HSF.
Neurovascular status
Assess for open wounds and any suspected concurrent injuries or fractures.
What is Holstein-Lewis fracture?
A fracture of the distal third of the humerus leading to entrapment of the radial nerve.
Consequence of Holstein-Lewis fracture.
Neuropraxia to radial nerve leading to loss of sensation in radial distribution and a wrist drop deformity.
Surgical management is indicated in such cases.
Investigations of HSF.
AP + lateral plain film radiographs of the humerus.
Make sure the elbow and shoulder are also visible.
CT imaging might be required for pre-operative planning but is not routinely done.
Types of management of HSF.
Conservative
Surgical
Conservative management of HSF.
Most HSF can be treated conservatively.
Re-alignment of the limb and then but in a functional humeral brace.
Regular follow-up with repeated plain film imaging should be done.
Full union should be achieved within 8-12 weeks.
Indications for conservative management.
< 20 degrees anterior angulation
< 30 degrees varus or valgus angulation
< 3cm of shortening
For very distal fractures a humeral brace will act as a fulcrum and can exaggerate the deformity.
In these cases a high-elbow cast should be applied instead.
Explain surgical management.
Open reduction and internal fixation with a plate.
Intramedullary nailing can also be done if there is a presence of pathological fractures, polytrauma or severely osteoporotic bones.
Complications of HSF.
Non-union
Mal-union
Varus angulation (more common with transverse fractures) - They rarely cause any functional limitations.
90% of radial nerve injuries will improve within 3 months without any intervention.
