Definition: Fracture of the humerus just proximal to the epicondyles.
-Classification of fracture based on mechanism:
Extension type (majority >80%; distal fx segment displaced posteriorly)
Flexion type (distal fx segment displaced anteriorly)
-Assessment should be made for neurovascular injuries.
Any diminished pulsations or capillary refill should cause concern for vascular compromise (arterial compression, tear, or compartment syndrome).
Place a continuous pulse oximetry probe on the affected hand to monitor bloodflow.
The radial, median, or ulnar nerves may be affected and should be assessed.
-Look for accompanying fractures of the forearm and wrist and xray those areas if suspected. -Nondisplaced fractures may follow up with orthopedics within 1 week after posterior long arm splinting (elbow at 90 degrees & forearm in neutral position) -Displaced fractures require promptpediatric orthopedic consultation for closed reduction in OR vs operative repair. -Obtain emergent orthopedic consultation for compartment syndrome, neurovascular compromise, or open fracture. -Partial reductions in ED likely just increase soft tissue swelling and delay definitive reduction and should be reserved for rare cases of vascular compromise.
