Humeral Shaft Fractures: Mechanism and Evaluation

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What is the most common mechanism of injury for humeral shaft fractures?

Direct trauma, especially MVA

What are the typical clinical presentations of patients with humeral shaft fractures?

Pain, swelling, and deformity of the upper arm

Why is careful NV (neurovascular) examination important in humeral shaft fractures?

Radial nerve is in close proximity to the humerus and can be injured

What are the classifications of distal humerus fractures?

Extra-articular, partial articular, complete articular

What are the treatment principles for humeral shaft fractures?

Restoration of articular axial alignment, stable internal fixation, early range of motion of the elbow

What is the recommended timing for treating closed humeral shaft fractures?

Within 24 hours or at 5-7 days

What is the recommended treatment for open humeral shaft fractures?

Emergent I&D, definitive reduction and internal fixation, temporary external fixation across elbow if definitive fixation not possible

What are the fracture patterns of humeral shaft fractures based on the stress applied?

Compressive, bending, torsional, torsion and bending

What is the most common type of humeral shaft fractures?

Compressive fractures of the proximal or distal humerus

What is the percentage of humeral shaft fractures that heal with nonsurgical management?

More than 90%

What is the common symptom noted following an olecranon process fracture?

Swelling and extensive bruising

What is the first step in treatment for a nondisplaced olecranon process fracture?

Posterior splint to flex the elbow 90°

What is a possible symptom of a coronoid process fracture?

Antecubital fossa tenderness and swelling

What is believed to be the secondary stabilizing source for the elbow during valgus stress?

Radial head

What is the most common elbow fracture among adults?

Radial head fracture

What imaging technique can usually demonstrate olecranon process fractures?

AP and lateral radiographs

What can displaced olecranon process fractures require for proper alignment of the bone?

Internal fixation with plates, screws, pins, or wires

What may cause an avulsion fracture of the coronoid process?

Forceful contraction of the brachialis muscle

What can produce loss of motion regardless of treatment after healing from an olecranon process fracture?

Olecranon process fracture

What can patients with radial head fractures experience?

Pain on the outer surface of the elbow and may not be able to pronate or supinate the forearm

Study Notes

Humeral Shaft Fractures

  • The most common mechanism of injury is a direct blow or a fall onto an outstretched hand.
  • Typical clinical presentations include pain, swelling, and deformity in the arm, with possible numbness or tingling in the hand or fingers.
  • Careful neurovascular (NV) examination is important to assess for nerve or blood vessel damage.

Classification of Distal Humerus Fractures

  • No specific classification mentioned.

Treatment Principles for Humeral Shaft Fractures

  • Treatment principles focus on restoring alignment, stabilizing the fracture, and allowing for early mobility.
  • Recommended timing for treating closed humeral shaft fractures is within 1-2 weeks.
  • Open humeral shaft fractures require urgent treatment, typically with surgical debridement and antibiotic administration.

Fracture Patterns and Types

  • Fracture patterns are based on the stress applied, including transverse, oblique, and spiral fractures.
  • The most common type of humeral shaft fracture is a transverse fracture.
  • Approximately 80-90% of humeral shaft fractures heal with nonsurgical management.

Olecranon Process Fractures

  • Common symptom is pain at the posterior elbow, especially with flexion.
  • First step in treatment for a nondisplaced olecranon process fracture is immobilization in a long arm cast.
  • Possible symptom of a coronoid process fracture is instability of the elbow.

Elbow Stability and Fractures

  • The coronoid process is believed to be the secondary stabilizing source for the elbow during valgus stress.
  • The most common elbow fracture among adults is a distal humerus fracture.

Imaging and Treatment

  • Olecranon process fractures can usually be demonstrated by X-ray or CT scan.
  • Displaced olecranon process fractures may require open reduction and internal fixation (ORIF) for proper alignment of the bone.
  • Avulsion fracture of the coronoid process can be caused by a violent traction force on the brachialis muscle.
  • Loss of motion can occur regardless of treatment after healing from an olecranon process fracture.
  • Patients with radial head fractures may experience elbow pain and stiffness, with possible instability.

Learn about the mechanism of injury for humeral shaft fractures, including direct trauma from MVAs and indirect trauma from falls. Understand the different fracture patterns based on the stress applied, and explore the clinical evaluation of humeral shaft fractures.

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