Weekly radiographs should be monitored to ensure appropriate fracture positioning with this technique.
Splinting humerus fracture skin#
The axillary end of the splint should be well padded, and desiccating powder can be applied to avoid skin complications in this area. To prevent varus deformity, the splint must often be molded into valgus (banana shaped). Fractures treated in coaptation splints may develop varus angulation due to the positioning of the arm against the body, especially if the axillary segment of the cast ends at or distal to the fracture ( Fig. A tubular stockinette can be placed around the splint and tied loosely around the neck to prevent the splint from slipping when above-the-shoulder immobilization is desired. For more proximal fractures, extending the lateral segment of the splint above the shoulder to the side of the neck will increase the amount of shoulder immobilization, which may result in improved pain control during the first week after injury. The splint is U-shaped and should be advanced as far up into the axilla as possible on the medial side of the arm and extend around the elbow to end above the deltoid on the lateral side ( Fig.
6Ĭoaptation splints are often the first choice for the initial stabilization of humeral shaft fractures in the emergency department. Other authors have reported that fractures that occur in the proximal one third of the humerus and are also associated with significant shoulder dysfunction at 12 weeks after injury have higher rates of nonunion and may be best treated with surgical fixation.
Splinting humerus fracture series#
Castellá et al 5 reported on a series of 30 humeral nonunions occurring after nonoperative management nine were in elderly women with the same fracture pattern-a long lateral butterfly fragment at the junction of the middle and distal thirds of the humerus. In contrast, shortening of the humerus does not appear to cause a functional problem. This amount of angulation may contribute to a decreased range of motion of the shoulder in particular, varus angulation is associated with loss of functional shoulder abduction. For example, problems with the nonoperative management of isolated humeral shaft fractures are more common when treating displaced transverse fractures, which are prone to nonunion, and in fractures with persistent angulation greater than 20 degrees. Nonoperative management is not ideal for certain fractures and in certain situations. These methods are discussed in subsections that follow below.
Other methods of nonoperative management include coaptation splints, hanging arm casts, and a variety of slings and swaths. The predictably good results achieved with functional bracing in particular have been noted by Sarmiento et al, 2– 4 who reported union rates near 99% when treating closed and low-energy open fractures. Nonsurgical management is currently considered the treatment of choice for most isolated humeral shaft fractures. Evaluation of the radial nerve is performed by testing wrist extension with grading of the motor function. It should be noted that a common mistake, often made after splinting the arm and wrist, is to observe extension of the fingers, which is a test of the intrinsic muscles of the hand and their innervation by the ulnar nerve, rather than the radial nerve. Thus, it is mandatory for the clinician to perform and document a motor examination specifically testing wrist extension for every humeral fracture at the time of initial presentation. Each method has advantages and disadvantages, which are discussed at length in this chapter.Īssociated injuries to the radial nerve occur in 6 to 17% of humeral shaft fractures, and are most commonly seen in displaced transverse fractures in the mid-diaphysis. For those fractures that require stabilization, both plating and nailing have similar results, although with slightly different complications. 1 Despite the nearly universal acceptance of intramedullary nailing for fractures of the long bones of the lower extremity, nonoperative management remains the treatment of choice for many humeral shaft factures.
Most humeral shaft fractures occur in the elderly as a result of a simple fall. Humeral shaft fractures account for about 1% of acute fractures in trauma registries, with an incidence of 14.5 per 100,000 people per year. Humeral Shaft Fractures Stephen Andrew Sems
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