THÔNG TIN TÀI LIỆU
) The emergency clinician should assess for other possible associated injuries including clavicle fractures, rib fractures, pneumothorax, thoracic vertebral fractures, and fractures of the humerus Fractures of the body and neck of the scapula are generally well visualized on plain radiographs; however, adequate definition of glenoid injuries may require a CT scan Fracture management is often conservative, with a sling and swathe, or a shoulder immobilizer for patient comfort, graduating to gentle range of motion exercise after weeks Orthopedic consultation is recommended given the infrequency of this injury and its association with other injuries Complications are not common except for possible malunion or functional impairment arising from associated thoracic injuries Injuries of the Humerus CLINICAL PEARLS AND PITFALLS Humeral fractures are associated with high-energy direct blows; any fracture with minimal trauma should raise suspicion for pathologic fracture or abuse Children in early adolescence are particularly high risk for proximal humerus physeal injuries due to the rapid growth and relative weakness of this portion of the bone Humerus fractures may result in radial nerve injury, which may be identified by numbness of the dorsum of the hand between the first and second metacarpals and decreased motor strength with wrist and thumb extension and forearm supination Orthopedic consultation is indicated for any humeral shaft fractures with rotational deformity or angulation greater than 15 to 20 degrees Proximal Humerus Fractures Injuries to the proximal humerus or humeral physis can occur after a fall on outstretched hand (FOOSH) ( Fig 111.13 ) Caution should be exercised in the evaluation of the infant patient, as these fractures may also be sustained in the setting of birth trauma and physical abuse On examination, the child may hold the arm in abduction and extension, with focal tenderness to palpation, localized swelling, and occasionally shortening of the affected extremity Routine radiographs are generally sufficient for diagnosis, and comparison views may be helpful in distinguishing a fracture from the normal physeal line The vast
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