If there are neurological or vascular deficits or involvement of joints then an orthopaedic referral is required.
- Common in older patients or due to direct trauma
- Upper third fragment adducted by the pectoralis major
- Middle segment abducted by the deltoid
- Trauma, Osteoporosis, Paget's disease, Pathological fracture
- Fall onto outstretched hand
- May involve greater tuberosity, less tuberosity, anatomical and surgical neck
- Localised pain, tenderness and possible deformity arm hanging with bruising
- Check radial nerve function as runs in the spiral groove
- Check axillary nerve by testing for sensation in the regimental badge area over the deltoid muscle and assessing upper limb muscle power.
- Assess for brachial plexus injury through distal neurological examination.
- Check peripheral pulses for vascular injury.
- FBC, ESR, U&E, Ca
- X-rays - include AP, trans-scapular (or Y) and axillary views.
- CT scan may be needed in difficult cases.
- Radial nerve damage
- Compound injury
- Refer to Trauma and orthopaedics if
- Gross angulation or comminuted fracture
- Compound Fracture
- Radial Nerve palsy
- Otherwise support arm with U slab plaster or hanging cast.
- Pad the arm well with cotton wool and then plaster slab.
- Give some simple analgesia.
- Refer to fracture clinic