Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Section I Fractures of the proximal humerus
- Section II Fractures of the humeral shaft
- Section III Fractures of the distal humerus
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section I - Fractures of the proximal humerus
from Chapter 2
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Section I Fractures of the proximal humerus
- Section II Fractures of the humeral shaft
- Section III Fractures of the distal humerus
- Chapter 3
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
GENERAL CONSIDERATIONS
The practicalities of surgical management of proximal humeral fractures are common to the various injuries treated. A generic description of the investigations required and practical set-up of the operating room will therefore be presented before discussing specific injuries.
Radiological assessment
It is essential that all shoulder fractures be assessed with a minimum of two shoulder views – the anteroposterior (AP) and axial views.
A scapular lateral completes the trauma series but is not always essential.
The axial view can be obtained successfully in most cases – in the rare instances where the patient will not permit sufficient movement of the injured limb away from the side, angled views (modified axial) should be obtained. Never miss a dislocation (too many are missed, and most of these have not had an axial view taken).
In complex cases a CT scan might assist, particularly in assessing whether the humeral head is intact and has anytuberosityattachmentsremaining.Ahumeralhead fragmentwithanattached tuberosity ismuchless likely to suffer avascular necrosis thanonewithnoremaining tuberosity attachments. Three-dimensional CT is particularly useful for assessing glenoid fossa fractures.
Anaesthesia
General anaesthesia or scalene blocks can be used. Even if general anaesthesia is selected, a scalene block can add useful analgesia.
The risk of phrenic nerve palsy and pneumothorax should be considered if a scalene block is to be used, particularly if there is already chest trauma (which not infrequently accompanies shoulder trauma).
Great care has to be taken to avoid interference with anaesthetic tubes and pipes by the surgeon or assistant in general anaesthetic cases.
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 8 - 21Publisher: Cambridge University PressPrint publication year: 2006