Upper Limb Fractures

Upper limb injuries are common, often seen in the elderly and children.

Clavicle

These fractures occur when a fall causes direct trauma onto the shoulder or on to the outstretched arm.

The Collar bone is so close to the surface of the skin, the fracture is usually visible due to the protruding bone and visible deformity. As with any fracture there is considerable pain, and bruising may be visible. The patient will often hold their arm in an attempt to relieve the pain.

Scapula

The scapula is the large flat bone which forms the rear portion of the shoulder. This bone rarely breaks, but if it does this is a red flag to ambulance personnel as high forces are needed to fracture the bone and as such, injuries associated with lung and chest trauma should be excluded.

Humerus

Location of humerus fractures:

  1. Proximal
  2. Mid Shaft
  3. Supracondylar

Humerus fractures occur commonly in the elderly and those with osteoporosis when a patient has fallen onto an outstretched arm or when trauma directly on the upper arm happens.

Ulna/Radius

Both forearm bones may fracture when falling onto an outstretched hand, although it is possible to fracture one bone in isolation.

Potential problems from fractures

  1. Circulatory compromise - regularly reassess for distal pulses
  2. Skin and soft tissures maybe under tension from underlying angulation of the fractured bone, this has the potential to lead to skin ischaemia or necrosis.
  3. If the injury has not been immobilaised correctly then a simple fracture could become compounded

Signs and Symptoms (SLIPDUCT B)

  1. Swelling
  2. Loss of function
  3. Irregularities on the bone surface such as depressions or lumps
  4. Pain
  5. Deformity
  6. Unnatural movement
  7. Crepitus, a sound similar to scrunching a bag of frozen peas heard/felt when the 2 ends of a broken bone grate together
  8. Tenderness
  9. Bruising of the surrounding skin

Management

GO DR SHAVPU ‹C› ACBC

Reassurance, Entonox for pain relief, Stop any haemorrhaging, Immobilise the affected area above and below injury, check for circulation of affected part, feel for distal pulses and for sensory loss numbness or pins and needles if there is any major deficit in circulation or sensory then the fracture will need to be reduced to near as normal, remove any tight clothing or jewellery before limb swelling occurs, apply ice or a cool pack to the affected part to help reduce swelling. Continually monitor the patients condition

Secondary Survey

ASHICE (consider)

Transport to Hospital

Professional Handover

 

Further Reading:

Shoulder Trauma

Fractures

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