Ortho Dx: A humerus fracture after a bike accident - Clinical Advisor

Ortho Dx: A humerus fracture after a bike accident

Slideshow

  • Radiographs taken in the emergency department of a19-year-old woman following a bicycle accident show a displaced midshaft humerus fracture.

    Slide

    Radiographs taken in the emergency department of a19-year-old woman following a bicycle accident show a displaced midshaft humerus fracture.

  • Radiographs taken in the emergency department of a19-year-old woman following a bicycle accident show a displaced midshaft humerus fracture.

    Slide

    Radiographs taken in the emergency department of a19-year-old woman following a bicycle accident show a displaced midshaft humerus fracture.

A 19-year-old woman presents 5 days after injuring her right arm during a bike accident. She was thrown over the handlebars and landed on her right elbow. Radiographs taken in the emergency department show a displaced midshaft humerus fracture. At that time, the arm was placed in a coaptation fiberglass splint, and the patient was instructed to make a follow-up appointment with the orthopedic department. On examination, gross motor and sensation in the right arm are intact.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

Most humeral shaft fractures heal well with nonoperative treatment. Initial management in the emergency department often includes a coaptation splint or U-shaped splint that goes into the axilla on the medial side and past the deltoid on the lateral side...

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Most humeral shaft fractures heal well with nonoperative treatment. Initial management in the emergency department often includes a coaptation splint or U-shaped splint that goes into the axilla on the medial side and past the deltoid on the lateral side of the arm. The splint is removed during the first follow-up office visit, generally at 4 to 5 days after the injury. A functional brace is then placed to provide circumferential compression around the fracture site.

Galveston and Sarmiento humeral braces are examples of functional braces, as they allow for immediate range of motion of the elbow and wrist. Keeping the arm in adduction is advised because the weight of the arm with gravity helps reduce the shaft fracture. Abduction and forward flexion of the arm creates displacing forces and should be avoided until the fracture heals. Criteria for acceptable alignment in the brace include less than 20 degrees of anterior angulation, less than 30 degrees of varus/valgus angulation, and less than 3 cm of shortening.1,2

Radial nerve palsy, a potential complication of humeral shaft fracture, can occur in up to 11% of cases and is more common in comminuted or oblique fracture patterns. Radial nerve palsy resolves spontaneously in 70% of cases in an average of 7 weeks.

Absolute indications for surgery include open fracture or neurovascular injury. Relative indications for open reduction and internal fixation include bilateral humerus fractures or polytrauma, pathologic fractures, irreducible fractures, and nonunions. Open reduction and internal fixation has a lower risk for complications compared with intramedullary nails and is the generally preferred surgical option.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Sarmiento A, Waddell JP, Latta LL. Diaphyseal humeral fractures: treatment options. Instr Course Lect. 2002;51:257-269.
  2. Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ. Management of humeral shaft fractures. J Am Acad Orthop Surg. 2012;20:423-433. 
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