Contents
"If both bone ends are in the same room they’ll heal".
May be a slight overstatement but in general humerus fractures are treated conservatively.
Mechanism
- FOOSH (compression force), MVA, direct blows (bending force), twisting injuries (torsion force), metastasis (in elderly)
Clinical
- Check for open wounds, other injuries
- pain, swelling, ± shortening, motion/crepitus at fracture site
- must test radial nerve function before and after treatment (note function of ECRL/ECRB, EDC, ECU, EIP, and EPL)
- Check neurovascular status, particularly Radial nerve (wrist/finger/thumb extension).
Investigations
- x-rays: AP and lateral full length views of humerus
Treatment
- Involves reduction with the patient sitting up allowing the arm to hang. You should support the wrist to reduce biceps/triceps tone. Then apply a sugar-tong splint.
- Mould the plaster as it sets to align and compress the fracture. Angulation of 20-30? is acceptable and rotation of 10-15?.
- Radial Nerve Palsy is very common and generally resolves spontaneously after 2-3 months. This should be treated with physiotherapy and a wrist splint and EMG studies carried out at 4-6 weeks.
If radial nerve function disappears after reduction then surgical exploration is needed.
Complications
- radial nerve injury: expect spontaneous recovery in 3-4 months, send for electromyography (EMG) at 3 weeks
- non/malunion
- decreased ROM
- compartment syndrome