Treatment of a spiral fracture8/12/2023 ![]() ![]() The fractures are then classified by their degree of displacement and angulation. Two-part, three-part and four-part fractures can occur. Neer classification: based on the four usual cleavage lines that occur due to the anatomy of the proximal head of the humerus (the articular segment or head, the lesser tuberosity, the greater tuberosity and the surgical neck/shaft).CT scan may be needed in difficult cases.X-rays - include AP, trans-scapular (or Y) and axillary views.If there are neurological or vascular deficits, orthopaedic referral is required.Assess for brachial plexus injury through distal neurological examination. Perform a neurological examination, particularly examining the axillary nerve by testing for sensation in the regimental badge area over the deltoid muscle and assessing upper limb muscle power.Assess for associated injuries to the arm/shoulder/chest wall/lungs.Establish whether osteoporosis is likely. Additional injuries to the shoulder girdle may also be present, such as scapular fractures causing a 'floating shoulder'. Proximal humerus fractures may either occur in isolation or be associated with concurrent dislocation of the glenohumeral joint. Pain, loss of shoulder/arm function, swelling and bruising.Humeral epiphysis separation can occur in adolescents. In younger age groups, trauma is likely to be of higher energy and the resulting injury more serious. In younger people, the same injury mechanism can cause fracture with co-existing shoulder dislocation.Middle age/elderly are most commonly affected.Can also occur during seizures or electric shock when fracture may be associated with a posterior shoulder dislocation.Usually after a fall on to an outstretched hand from standing height.Proximal humerus fractures often occur in older patients after a low-energy fall. Distal humeral fractures are discussed in the separate Elbow Injuries and Fractures article. Fractures of the distal humerus in the adult account for approximately one third of all humeral fractures. One method is to classify them as:įracture of the supracondylar (distal) humerus is one of the most common fractures encountered in children. In the elderly, pathological fracture should be considered.Ĭlassification of humeral fractures is difficult. In children the possibility of non-accidental injury should be borne in mind when taking the history and examining the child, especially in very young children. Mechanism of injuryįractures of the humerus usually result from falls or direct trauma. The medial and lateral epicondyles are at the lower end of the humerus, and the joint surface consists of the capitulum (articulates with the head of the radius) and the trochlea (articulates with the ulna). The radial nerve runs posteriorly around the middle third of the humeral shaft in the spiral groove. ![]() The long head of biceps runs between the tuberosities in the bicipital groove, and the surgical neck is just below the greater and lesser tuberosities. The anatomical neck separates the greater and lesser tuberosities from the humeral head. The humeral head articulates with the glenoid fossa of the scapula. ![]() Compartment syndrome threatens limb viability (possibly requiring amputation) and survival.BDB, Public domain, via Wikimedia Commonsīy BDB, Public domain, via Wikimedia Commons Over the long term, it can cause contractures, sensory deficits, and paralysis. Untreated compartment syndrome can lead to rhabdomyolysis, hyperkalemia, and infection. In addition to fractures, musculoskeletal injuries include Joint dislocations. Most fractures result from a single, significant force applied to normal bone. Risk is high with forearm fractures that involve both the radius and ulna, tibial plateau fractures (proximal tibial fractures that extend into the joint space), or tibial shaft fractures ( 1 Complications references A fracture is a break in a bone. Crush injuries or markedly comminuted fractures are a common cause, increasing tissue pressure as edema develops. read more : Tissue pressure increases in a closed fascial space, disrupting the vascular supply and reducing tissue perfusion. The earliest symptom is pain out of proportion to the severity of injury. Compartment syndrome Compartment Syndrome Compartment syndrome is increased tissue pressure within a closed fascial space, resulting in tissue ischemia.
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