![]() ![]() If a radial nerve injury is present, active manipulation is not recommended. Occasionally a hanging U-slab plaster of Paris (POP) is required (Figure 2). Middle third fractures of the humeral shaft are managed with a collar and cuff. What is the usual ED management for this fracture? Unable to achieve or maintain reduction (including if ED is not experienced in fracture reduction, splinting or casting)Īcute referral is needed if neurological signs have occurred after manipulation of the fracture, as this may indicate the radial nerve has become entrapped.Extreme swelling/compartment syndrome - extremely rare with humeral fractures. ![]() Neurovascular injury with fracture (radial nerve palsy).Indications for prompt consultation include: Axial alignment within 10 degrees - assessed on imagingĨ.This allows the weight of the arm itself to act as traction across the fracture. ![]() under the influence of gravity) to good alignment and apposition using a collar and cuff. When is reduction (non-operative and operative) required? Look for evidence of bone cysts or other pathologic fractures.įigure 1: Six year old boy with a transverse fracture of the shaft of the humerus. What do they look like on x-ray?įractures of the humeral shaft are often either transverse fractures or spiral. What radiological investigations should be ordered?Īnteroposterior (AP) and lateral views of the humerus should be ordered. Sensory loss will be in the dorsum of the 1 st web space. There will be loss of finger metacarpophalangeal (MCP) extension and loss of wrist extension. Radial nerve palsy can occur with a fracture at the junction of the middle and distal thirds of the shaft. Deformity may not be obvious due to swelling and the dependency of the arm. The arm is usually swollen and tender and the child will be unwilling to move the arm. Careful history and examination are required to determine the child at risk. Spiral fractures of the humerus in infants and toddlers are strongly linked with non-accidental injury. This fracture is a hallmark of non-accidental injury. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of non-accidental injury. Humeral shaft fractures are the second most common birth fracture. Pathological fractures through a humeral simple bone cyst are relatively common after minimal trauma in children over 7 years old. Transverse and short oblique fractures are generally as a result from direct trauma, whereas spiral fractures are caused by indirect twisting, as with a fall. These fractures are uncommon and account for 2-5% of all fractures in children. How common are they and how do they occur?
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