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Mid-diaphyseal segmental fracture with ipsilateral pilon fracture
7%
112/1508
Mid-diaphyseal fracture with radial nerve palsy from nonballistic penetrating injury
8%
120/1508
Proximal one-third oblique fracture
11%
163/1508
Mid-diaphyseal closed fracture with a radial nerve palsy on presentation
67%
1012/1508
Mid-diaphyseal fracture with a L1 burst fracture and paraplegia on presentation
6%
92/1508
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A closed mid-diaphyseal humerus fracture with a radial nerve palsy on presentation is not a contraindication to functional brace management. Commonly accepted parameters for closed treatment include less than 30 degrees of varus angulation, 20 degrees of anterior/posterior angulation, and 3 cm of shortening. Operative indications are: associated vascular injuries, bilateral humeral shaft fractures, polytrauma patient (including paraplegia), segmental fractures, injury to the brachial plexus, pathological fractures, floating elbow, and floating shoulder. The article by Rutgers and Ring found that proximal one-third oblique humeral shaft fractures had an unacceptably high 29% rate of nonunion treated with a functional brace. The article by Sarmiento et al found a 97% rate of union, a radial nerve palsy incidence of 11%, and no contraindication to the use of functional braces in humeral shaft fractures associated with radial nerve palsy. The review article by Defranco and Lawton states that 70% of these radial nerve injuries recover spontaneously. They note that it "seems reasonable, however, to consider surgical intervention (radial nerve exploration) between 4 and 6 months based on the patient’s clinical course."
2.5
(64)
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