Makindo Medical Notes"One small step for man, one large step for Makindo" |
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โ ๏ธ Always document a neurovascular exam (radial, ulnar, median, axillary nerves + pulses) for all humeral fractures.
| INJURY SITE | KEY POINTS (Mechanism + Pitfalls) | MANAGEMENT (ED + Follow-up) |
|---|---|---|
| Neck of Humerus | ๐ค FOOSH, common in elderly. โก Axillary nerve injury โ โregimental badgeโ numbness, deltoid weakness. | ๐ฉน Collar & cuff / U-slab. ๐ Fracture clinic. ๐จ Ortho if young/active (fixation). |
| Greater Tuberosity | ๐ Fall onto shoulder/hand. โ ๏ธ Rotator cuff dysfunction, stiffness/impingement if displaced. | ๐ฉน Collar & cuff. Avoid early abduction. ๐ Clinic โ fixation if >5 mm displacement. |
| Shaft (mid-third) | ๐ Twisting โ spiral #; ๐ฅ blow โ transverse #. โก Radial nerve palsy (wrist drop). Rare in kids โ consider NAI. | ๐ฉน Hanging U-slab; some need ORIF/IM nail. ๐ Clinic. ๐จ Ortho if radial nerve injury. |
| Supracondylar (children) | ๐คธ FOOSH. โ ๏ธ Brachial artery injury, nerve palsy, compartment syndrome. | Undisplaced โ POP 90ยฐ. Displaced โ urgent MUA ยฑ K-wires. ๐ Clinic if stable. |
| Lateral Epicondyle (children) | ๐ค Fall. Rare. โ ๏ธ Non-union risk. | ๐ฉน POP. ๐ Clinic; fixation if >2 mm displaced. |
| Medial Epicondyle (children) | โก Avulsion with dislocation. โ ๏ธ Ulnar nerve palsy. | ๐ฉน POP. ๐จ Ortho if displaced/entrapped. ๐ Clinic otherwise. |
๐ Exam Pearls:
โ Neck โ Axillary nerve.
โ Shaft โ Radial nerve (wrist drop).
โ Supracondylar (kids) โ vascular compromise.
โ Always check for compartment syndrome.
| INJURY SITE | KEY POINTS (Mechanism + Pitfalls) | MANAGEMENT (ED + Follow-up) |
|---|---|---|
| Radial head & neck | ๐ค FOOSH. โก Check posterior interosseous nerve. | ๐ฉน Collar & cuff. ๐ Clinic if displaced. โ Discharge if simple. |
| Shaft | ๐ค FOOSH or ๐ฅ blow. โก Galeazzi = shaft # + DRUJ dislocation. | ๐ฉน Above elbow POP ยฑ MUA. ๐จ Ortho if Galeazzi. ๐ Clinic otherwise. |
| Distal metaphysis โ Collesโ | ๐ค FOOSH (elderly). โก Median nerve injury. | 1๏ธโฃ High-energy/intra-articular โ urgent ortho. 2๏ธโฃ Frail/low demand โ POP. 3๏ธโฃ Others โ MUA + POP. ๐ Clinic vs ๐จ Ortho depending on position. |
| Distal metaphysis โ Smithโs / Bartonโs | ๐ค FOOSH. โก Median nerve risk. | ๐ฉน Above elbow POP (wrist dorsiflexed). ๐จ Immediate ortho referral. |
| Styloid | ๐ค FOOSH. Usually benign. | ๐ฉน Below elbow POP. ๐ Clinic. |
| Buckle / Torus (children) | ๐ค FOOSH. โ ๏ธ Missed fractures possible. | Stable โ splint + discharge. Other โ POP. ๐ Clinic if deformity. ๐จ Ortho if severe. |
| Olecranon | ๐ค Fall on elbow. โ ๏ธ Open #, triceps displacement, ulnar nerve risk. | Hairline โ POP. Displaced/open โ ๐จ Ortho (washout/fixation). ๐ Clinic if simple. |
๐ Exam Pearls:
โ Radial head/neck โ check PIN.
โ Shaft โ think Galeazzi.
โ Collesโ โ elderly + median nerve.
โ Smithโs/Bartonโs โ unstable.
โ Buckle (kids) โ splint + discharge.
โ Olecranon โ beware triceps pull & ulnar nerve.
| INJURY SITE | KEY POINTS (Mechanism + Pitfalls) | MANAGEMENT (ED + Follow-up) |
|---|---|---|
| Triquetral # | ๐ค Hyperextension. โ Full recovery expected. | ๐ฉน Splint or POP. ๐ Discharge or ๐ clinic. |
| Lunate dislocation | ๐ค FOOSH / ๐ RTC. โ ๏ธ Easily missed (โspilled teacupโ). | ๐ฉน Splint/POP. ๐จ Ortho referral for reduction & fixation. |
| Bennettโs # (1st MC base) | ๐ Blow or forced abduction. โ ๏ธ Unstable intra-articular. | ๐ฉน POP if extra-articular. ๐จ Ortho if intra-articular/displaced. |
| UCL injury (Skierโs thumb) | ๐ค Forcible abduction. โ ๏ธ Missed โ permanent disability. | ๐ฉน Scaphoid backslab. ๐จ Ortho if laxity/avulsion. |
| 5th Metacarpal Neck (Boxerโs #) | ๐ Punch. โ ๏ธ Infection risk (โfight biteโ). | Closed โค40ยฐ โ buddy strap. Open/bite โ washout + abx + buddy strap. ๐ Discharge or ๐จ Ortho. |
| 5th MC Shaft | ๐ค Trauma. โ ๏ธ Check rotation. | ๐ฉน POP. ๐ Hand clinic. |
| Other Metacarpals | ๐ค Direct blow. โ ๏ธ Shortening, rotation. | Buddy strap / POP / ๐จ Ortho depending on severity. |
| Phalanges | ๐ค Simple undisplaced. โ ๏ธ May angulate/rotate. | Correct >10ยฐ under ring block. ๐ฉน Buddy strap. ๐ Hand clinic. |
| Terminal phalanx | ๐ค Direct blow/laceration. โ ๏ธ Nail bed or open injury. | Closed โ strap. Open โ washout + abx. Nail bed injury โ replace nail. ๐จ Ortho if severe. |
| Mallet finger | ๐ค Forced flexion. โ ๏ธ Dropped fingertip. | ๐ฉน Mallet splint ร6 weeks. ๐ Discharge or ๐ clinic if avulsion. |
| MCP/IP dislocations | ๐ค Hyperextension. โ ๏ธ Associated # possible. | ๐ง Reduce under LA. ๐ฉน Buddy strap. ๐ Clinic. ๐จ Ortho if irreducible. |
| Cuts & Bites | โ๏ธ Risk to tendon, nerve, artery. ๐ถ Bites โ infection risk. | ๐งผ Irrigate, document neurology. Minor tendon (<1/3) โ close. >2/3 tendon/artery/nerve โ ๐จ Ortho. All bites โ discuss with ortho. |
๐ Exam Pearls:
โ Boxerโs # โ check for โfight biteโ.
โ Bennettโs # โ unstable โ ortho.
โ Mallet finger โ splint 6 weeks.
โ Lunate dislocation โ look for โspilled teacupโ.
โ UCL injury โ test laxity carefully.