HUMERAL SHAFT FRACTURES
Whenever a patient presents with a possible humeral fracture, inspect the upper arm for swelling, ecchymosis, deformity, and open wounds. Palpate the area of maximal tenderness, and assess the joint above (shoulder) and below (elbow) for injury. Always perform a thorough distal neurovascular examination. After a fracture of the humeral shaft, the arm should be supported and immobilized.
When gross fracture angulation occurs, emergency care personnel should restore overall alignment of the arm by applying longitudinal traction. This is best accomplished with conscious sedation of the patient to avoid patient guarding and muscle spasm that may prevent adequate reduction of the fracture. Once the fracture is reduced, someone must maintain alignment of the fracture manually while a well-padded splint is applied to the arm to provide stability and maintain the reduction. For humeral shaft fractures, a coaptation splint typically works best. The entire injured limb can then be placed in a sling for added comfort.
Fracture Of Shaft Of Humerus
Fractures of the humeral shaft are generally due to direct trauma and can present as different fracture patterns, such as transverse, spiral or oblique, and comminuted. Nonsurgical treatment is acceptable in most instances, but the choice of treatment is based on the type and location of the fracture, concomitant injuries, and age and condition of the patient. For closed fractures, a coaptation splint or a collar and a lightweight, hanging arm cast may be placed initially. About 10 days after injury, when the initial swelling has subsided, the patient is fitted with a fracture brace, which allows the patient to exercise the hand, wrist, elbow, and shoulder while maintaining fracture alignment.