12 July 2022 at 14:01:31
Humeral brace (from Plaster room). Check neurological status before and after application of brace.
On-line referral to VFC
Clinical presentation
This can be a high energy trauma in a young patient or low-engery in older patients. Twisting mechanism tend to create spiral fracture pattern whilst direct trauma create transverse fracture patterns. Patient would complaint of pain at the fracture site and limited movement. Often there is significant bruising in the upper arm.
Clinical evaluation
Assessment of nerve function should be clearly documented. Radial nerve function is most commonly affected, particularly in spiral distal one-third fractures (Almost up to 1 in 4 patients with distal fracture have radial neuraprexia)
To test the upper limb neurology is quick and simple to do: MAKE SURE THE FINDINGS ARE CLEARLY DOCUMENTED.
Other important assessments include: (refer to oncall ortho if any of these features)
open fracture
vascular function
ipsilateral forearm fracture (floating elbow injury)
compartment syndrome
A standard AP and lateral XR of the upper arm will show the fracture configuration.
A&E management
collar and cuff / humeral brace - If the arm is too swollen for brace, then collar and cuff for the 1st week is sufficient. (encourage patient to hang their arm to allow gravity to reduce the fracture). If the arm is amenable for brace, then contact the Plaster Room (ext 35443) for humeral brace fitting. IT IS IMPORTANT TO REASSESS AND DOCUMENT THE NERVE FUNCTION after application of brace.
simple anaglesia
On-line referral to VFC