![]() Parameters for acceptable reduction limited by small retrospective studies without correspondence to the following validated functional outcome scores: 90 degrees for 4 weeks. Magnetic resonance imaging (MRI) typically not necessary, unless suspect pathologic fracture and trying to identify lesion.Ĭlassification: There is not a commonly used “named” fracture classification for humeral shaft fractures.Īrbeitsgemeinschaft für osteosynthesefrage/orthopaedic trauma association (AO/OTA) classification:Ĭoaptation splint for initial management-U-shaped splint splint extending from axilla to the neck laterally and sling. Radiographs-anteroposterior (AP) and lateral of the humerus.Īlways obtain X-rays of the joint above and below-shoulder and elbow AP and lateral.Ĭomputed tomography (CT) not indicated in fractures of the humeral shaft. Ulnar nerve travels posterior to the medial epicondyle.Īxillary nerve wraps around the proximal humerus from medial to lateral. Radial nerve-courses along spiral groove, and crosses from medial to lateral approximately 20 cm proximal to medial epicondyle. 22.2 Structures at risk associated with a posterior approach ( red line) to the humerus. Adduction of distal fragment by pectoralis major and deltoid.įracture between pectoralis major and deltoid-adduction and internal rotation of proximal fragment by pectoralis major, teres major, and latissimus dorsi abduction of distal fragment by deltoid.įracture distal to deltoid-abduction and flexion of proximal fragment by deltoid, and shortening of distal fragment due to pull from triceps, biceps, and coracobrachialis. 22.1 Deforming forces associated with a proximal humerus fracture (a) proximal to the pectoralis major insertion (b) between the deltoid and pectoralis insertion (c) and distal to the deltoid insertion.įracture proximal to pectoralis major insertion-external rotation and abduction of the proximal fragment due to rotator cuff. Commonly associated with radial nerve palsy.ĭeforming forces-deltoid, pectoralis major, brachialis, coracobrachialis, brachioradialis, biceps, and triceps (▶ Fig. Holstein Lewis-spiral distal third shaft fracture. Perform thorough sensory, motor, and vascular examination to identify any deficits. ![]() High-energy trauma more common in younger patients. Fall from standing more common in elderly.
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