Distal Humerus Fractures Clinical Presentation

Updated: Aug 31, 2021
  • Author: Edward Yian, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB  more...
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Presentation

History

A thorough patient history must be taken in the initial evaluation of these patients. Medical history, surgical history (especially pertaining to the injured extremity), medication use, nonmedication drug use, occupation, and smoking history should be ascertained. In an elderly patient, the reason for the fall must be investigated.

The mechanism of injury also can help to identify other associated bony or ligamentous injuries. Questions regarding the speed of the motor vehicle accident (MVA) or the height from which a fall occurred and the position of the arm at impact should be asked.

Understanding the premorbid condition of the patient's injured extremity also is important, as is ascertaining any preexisting limitations, such as degenerative or traumatic arthritis, instability, stiffness, or neurologic abnormalities (acute or chronic), that may affect treatment.

With high-energy injuries, associated injuries to the head, chest, abdomen, spine, or pelvis must be excluded. Standard screening radiographs, including radiographs of the pelvis, spine, and chest, are obtained (see Workup).

Next:

Physical Examination

Physical examination of the patient should include examination of the injured extremity and a thorough primary and secondary survey to determine if any associated injuries are present.

A complete examination of the neurovascular status of the extremity should be conducted. An accurate assessment should be made of the sensory and motor contributions of the median (including the anterior interosseous), ulnar, and radial (including the posterior interosseous) nerves, as well as the medial and lateral antebrachial cutaneous nerves. The brachial artery and median nerves lie anterior to the elbow joint and are at risk for disruption.

The distal pulses should be palpated and the capillary refills should be assessed, with comparisons made to the contralateral upper extremity. If questions regarding vascular status arise, duplex Doppler studies or angiography should be performed (see Workup).

Inspection and palpation also should be part of the examination. Open wounds communicating with the joint are common with high-energy injuries. These wounds should initially be treated with antibiotics and tetanus prophylaxis. A povidone-iodine dressing should be placed over the wound to prevent further wound colonization and exposure.

The skin should be examined for bruising, ecchymosis, or lacerations, with these findings taken into consideration, especially if operative intervention is to be initiated. Bruising, ecchymosis, or lacerations may represent significant ligamentous damage and resultant instability.

A well-padded, well-molded splint with the elbow in slight flexion and neutral rotation provides stability and pain relief until definitive treatment is possible. The splint should be applied with a nonconstrictive dressing. Signs of compartment syndrome of the forearm or upper arm also should be clinically investigated.

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