Arm
Upper Arm
Proximal Humerus Fracture
MC in elderly
Concern for axillary nerve damage ➔ ↓ lateral deltoid sensory (Sergeant's patch)
DX: AP, axillary, Y-view
Neer Classification
One Part - 1 fx line but no fragments
TX with sling (swathe not necessary), ice, pain control
Two Part - 2 fx lines ➔ 1 displaced fragment
Three Part - 3 fx lines ➔ 2 displaced fragments
Four Part - 4 fracture lines ➔ 3 displaced fragments with dislocation of head from glenoid
Ortho referral if a one part fx that involves anatomic neck (↑ risk of osteonecrosis)
Or if severely displaced
Mid-Shaft Humerus Fracture
Bimodal age distribution
Concern for brachial artery or median/radial nerve injury
TX
Coaptation splint
From axilla, around elbow, over deltoid
Surgery for neurovascular or open/severely displaced
Coaptation splint
Elbow
Distal Humerus Fracture (Supracondylar)
MC in kids
Extension fracture (MC) from FOOSH
Gartland Type I - Non-displaced
Anterior humeral line transects middle third of capitellum
Gartland Type II - Displaced with posterior hinge
Gartland Type III - Completely displaced
Flexion fracture is uncommon
MOI: direct elbow blow - ↑ risk of ulnar nerve damage
DX
AP and lateral elbow (abnormal anterior humerus line)
Anterior or posterior fat pad indicates effusion from fx
TX
Type I ➔ posterior splint from wrist to axilla 90° elbow flexion
Type II & III ➔ ortho to decide on surgery
Radial Head Fracture
FOOSH ➔ elbow pain
Pronate and supinate forearm while palpating radial head ➔ joint tenderness
DX (radiologist will see non-displaced fx)
Anterior or posterior fat pad indicates effusion from fx
TX
Nondisplaced ➔ sling for 2 days tops (start using it)
Ortho f/u if displaced; immediate reduction of associated elbow dislocation
Olecranon (proximal ulna) Fracture
AKA elbow fracture
Direct trauma to elbow or FOOSH
Bimodal age distribution
Concern for ulnar nerve injury
TX with posterior splint, ortho referral if displaced
Posterior splint
Elbow Dislocation
Axial loading with external rotation of forearm
MC in kids/young adults
Concern for ulnar nerve and brachial artery injury
Immediate closed reduction followed by posterior splint
ORIF if fractures present or persistent instability
Radial Head Subluxation (Nursemaid's Elbow)
Partial dislocation of head of radius
MC in kids <5yo (immature annular ligament of radius)
Tugging on outstretched and pronated arm
Kid won't want to move arm
TX: Supinate forearm and flex elbow
click into place followed by pain relief
Lower Arm
Galeazzi
Radius Fracture + Ulnar Dislocation
Fall with extended wrist and pronated forearm
Distal radius fx & dislocation of ulnar head
The Radswiki, Galeazzi, via Radiopedia
Monteggia
Ulna Fracture + Radial Dislocation
Fall with extended elbow and pronated forearm
Proximal ulnar shaft & dislocation of radial head
Assoc Prof Frank Gaillard, Monteggia, via Radiopedia
TX: reduction & double sugar tong
Distal Radius Fracture
Colles (MC)
Fall on outstretched extended hand
Distal radius dorsally displaced (dinner fork)
Barton fracture: Dorsal avulsion of radius
Smith
Fall on outstretched flexed hand
Distal radius ventrally displaced (garden spade)
Reverse Barton: Volar avulsion of radius
Most likely needs OR
Dr Maciej Debowski, Distal radial fractures, via Radiopedia
TX: reduction & sugar tong