Humeral fractures and injuries

Neck

Fall onto limb –usually elderly pt

Displacement may be severe without functional compromise Axillary nerve injury – may recover with time

Collar & cuff. Hanging U-slab if displaced.

Fracture clinic for most.

Immediate referral to ortho for young, active patients on day of injury

Greater tuberosity

Fall onto shoulder or outstretched arm

Displacement may lead to cuff dysfunction stiffness or impingement

Collar and cuff. Avoid

active elevation/abduction

Fracture clinic

Shaft – usually mid third

Indirect twisting force causes spiral # Direct blow –transverse #

Rare in children – consider NAI Proximal half is common site for pathological # Radial nerve injury – wrist drop. Recovery usually spontaneous if closed

Occasionally require internal fixation. Hanging U slab may be useful for analgesia

Fracture clinic unless radial nerve injury in which case, discuss with Orth team

Supracondylar

Common in children. Fall on outstretched arm

Significant arterial and nerve injury common. Requires careful assessment

Undisplaced – POP with elbow at 90^o. Displaced or significant angulation– POP and refer for MUA

Fracture clinic if MUA not required and no extreme swelling. Most heal well within 3 weeks

Lateral epicondyle

Rare. Mostly children. Caused by a fall

May require fixation if displaced

As above

As above

Medial epicondyle

Usually children –avulsed by flexor muscles during a fall, dislocation or subluxation of the elbow

Ulnar nerve injury

As for supracondylar injuries

As for supracondylar injuries