9/1/2023 0 Comments Elbow humerus fracture![]() With the high-energy injury there is typically extensive comminution of the articular surface and metaphyseal region, and there can be bone loss in open injuries ( Fig. High-energy injuries differ from low-energy injuries in the proportion of open fractures and the incidence of injuries to more than one organ system. (b) After open reduction and internal fixation with an olecranon osteotomy. (a) A distal humerus fracture in an elderly woman. (b) After open reduction and internal fixation. (a) A high-energy distal humerus fracture in a 28-year-old man. 16.1) and elderly patients, often with osteoporosis, sustaining low-energy fractures in ground-level falls ( Fig. There are two distinct subgroups of patients in whom these injuries occur 1, 2: younger patients sustaining high-energy fractures ( Fig. Approximately 90 percent of patients who have a radial nerve palsy recover within 4 to 6 months, according to the "Handbook of Fractures.Articular fractures of the distal humerus represent only about 2% of all fractures, but they always present a challenge to the treating orthopaedic surgeon because of the complex anatomy of the distal humerus and elbow. The radial nerve can be injured at the time of injury or during the post-fracture management. Some deformity of the humerus is an acceptable clinical outcome. Malunion refers to poor and incomplete healing of the fracture. Nonunion refers to no signs of healing of the fracture site. Vascular injuries noticed at the initial time of surgery are treated surgically. Side effects of humeral-shaft fractures treated with nonoperative methods include nonunion, malunion, nonresolution of a radial nerve palsy and infection. The study proved that functional bracing was a definitive way to treat humeral-shaft fractures. Augusto Sarmiento, an orthopedic surgeon at the University of Miami, wrote an article in the "Journal of Bone and Joint Surgery" in 2000 about the effectiveness of functional bracing of humeral-shaft fractures.Ī total of 922 patients with humeral-shaft fractures participated in a study conducted by Sarmiento, who discovered that average time to healing for a humeral-shaft fracture was 11.5 weeks, with a healing range from 5 to 22 weeks. The functional brace allows for shoulder and elbow movement, which helps to maintain range of motion of these joints during the healing process of the fracture.ĭr. It does allow for some movement to take place at the fracture site during healing. The functional brace extends from just below the shoulder to just above the elbow to overlie the humerus. The tension on the fracture brace can be adjusted to help improve alignment of the fracture fragments. ![]() Functional bracing and a hanging cast are the definitive nonoperative options for management of humeral-shaft fractures. A coaptation splint is typically used for 7 to 10 days, until more definitive treatment is performed, such as with a functional brace, cast or surgery.įunctional bracing is typically applied 7 to 10 days after the humeral-shaft fracture, but can also be an initial option for treatment.A coaptation splint is a 'U-shaped' splint that is placed under the axilla or arm-pit, wrapped around the elbow and terminating near the top of the shoulder.An orthopedic surgeon or qualified healthcare provider should be consulted regarding the treatment of all humerus fractures. Indications for surgical repair of humeral-shaft fractures include injury to vessels, severe soft tissue injury, an open fracture where bone penetrates skin, a pathologic fracture and severe displacement of the fracture fragments.įractures of the proximal or distal humerus are not treated with coaptation splinting. Most humeral-shaft fractures are treated with an initial coaptation, splint followed by either a functional brace or a hanging arm cast. Treatments for humerus fractures are typically nonoperative however, some require surgery to improve clinical outcomes. When the skin is broken during a fracture, it is known as an open fracture. Most humerus fractures are closed injuries where there is no break in the skin overlying the fracture site. The shaft of the humerus can be fractured near the shoulder, near the elbow or between the shoulder and the elbow.
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