Upper Limb Fractures: Humeral neck

Question 1

are proximal humeral neck fractures common or uncommon

Answer 1

common

Question 2

what is the typical history of a humeral neck fracture

Answer 2

low energy injury in osteoporotic bone due to fall on outstretched hand or directly onto shouler

Question 3

what is the most common fracture pattern seen in humeral neck fractures

Answer 3

fracture of surgical neck with medial displacement of humeral shaft

Question 4

what causes a medial displacement of the humeral shaft in a humeral neck fracture

Answer 4

due to the pull of the pectoralis major muscle

Question 5

what does avulsed mean

Answer 5

a tearing away/torn off of

Question 6

describe what may happen to the muscles of the rotator cuff in relation to the greater and lesser tuberosities in a humeral fracture

Answer 6

muscles may be avulsed from their attachments with the greater and lesser tuberosities

Question 7

what muscles may be avulsed from their attachment at the greater tuberosity of the humerus in a humeral neck fracture

Answer 7

supraspinatus, infraspinatus, teres minor

Question 8

what muscle may be avulsed from their at the lesser tuberosity of the humerus in a humeral neck fracture

Answer 8

subscapularis

Question 9

what are some uncommon fracture patterns that can occur at the proximal humerus

Answer 9

isolated fracture of greater tuberosity, or head-splitting intra-articular fractures

Question 10

describe how many undisplaced proximal humerus fractures are treated

Answer 10

conservatively with a sling and gradual return to mobilisation

Question 11

with displaced fractures what occurrence helps improve the position of the humerus

Answer 11

when muscle spasm settles

Question 12

describe how persistently displaced humeral neck fractures are treated

Answer 12

with internal fixation, with wires, plates, screws or intramedullary(IM) nails

Question 13

what complications can occur with internal fixation of humeral neck fractures especially in older patients

Answer 13

stiffness, chronic pain, failure of fixation

Question 14

what patterns of humeral shaft fracture can occur by falling, with or without twisting injury

Answer 14

oblique or spiral fractures

Question 15

what patterns of humeral shaft fracture can occur by direct trauma

Answer 15

transverse or comminuted fractures

Question 16

what nerve is susceptible to injury in humeral shaft fractures, and where is it

Answer 16

radial nerve, in the spiral groove

Question 17

what presentation suggests loss of nerve function in a humeral shaft fracture

Answer 17

presents with wrist drop and loss of sensation in first dorsal web space
(radial nerve)

Question 18

what are most cases of humeral shaft fracture treated with

Answer 18

non-operatively with humeral brace which compresses the fragments into acceptable alignments and provides some stability

Question 19

what treatment is used for polytrauma and for non union humeral shaft fractures

Answer 19

polytrauma = IM nail

non union = plating and bone grafting