Deviation in the Standard of Orthopedic Care of Humerus (Upper Arm) Fracture

Evaluate breaches in the standard of care by asking, answering, and evaluating the following questions to determine if there was or was not a Deviation in the Standard of Orthopedic Care of Humerus (Upper Arm) Fracture

Answer the following questions to find out if the standard of care was followed for your case.

  • With what symptoms did the patient present? (Choose all that apply)
    Shoulder pain
    Arm swelling
    Ecchymosis
    Answer unknown
    Why is this important?
    The shoulder girdle is often extremely swollen after a proximal humeral fracture, with ecchymosis often tracking down the arm and into the chest.
    (2007) 23 EHANDC 4 415-424

  • Did the patient sustain a fall? Why is this important?
    Answer this question
    
A humerus fracture is usually is sustained after a simple fall onto the outstretched limb or onto the shoulder itself.

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  • With which of the following risk factors did the patient present? Why is this important?
    Answer this question
    
Risk factors are useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
The physical examination should include assessment of the skin and soft tissues to reveal the presence of an open injury or significant soft tissue damage. Although neurovascular disruption is thought to be uncommon with these fractures, a complete evaluation of these structures should be performed to rule out any such injuries.

    (2007) 23 EHANDC 4 415-424 



  • Were diagnostic imaging studies performed on the injured arm? Why is this important?
    Answer this question
    
The mainstay in diagnosing distal humerus fractures is conventional radiography, including views of the wrist and shoulder to rule out concomitant injury. Standard views, including antero-posterior, lateral, and oblique views, can generally confirm the presence of and help to characterize distal humerus fractures.

    (2009) 34 JLHASU 1 176-190 



  • Were steps taken to treat soft tissue injury? Why is this important?
    Answer this question
    
Bony and soft tissue anatomy must be restored early in unstable or displaced fractures to achieve success.

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  • What type of humerus fracture did the patient sustain? Why is this important?
    Answer this question
    
The humerus is the largest bone in the upper extremity, fractures of the proximal humerus represent the second most common fracture type of the upper extremity and the third most common fracture in patients older than 65 years.

    (2008) 39 EORCNA 4 393-403 



  • What type of proximal humerus fracture did the patient sustain? Why is this important?
    Answer this question
    
Proximal humerus fractures are non-displaced or minimally displaced injuries, that can be managed adequately with closed treatment and early functional rehabilitation.

    (2007) 23 EHANDC 4 449-456 



  • Which type of humeral shaft fracture did the patient sustain? Why is this important?
    Answer this question
    
The classification of humeral shaft fractures has commonly been based on the nature and location of the primary fracture lines. Based on the direction and character of fracture they have classified into transverse, oblique, spiral, segmental and comminuted.

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  • Which of the following treatments were initiated? Why is this important?
    Answer this question
    
Closed reduction will be sufficient to realign the bone back into its anatomic position in an un-displaced humerus fracture.

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  • Was a post reduction x-ray obtained? Why is this important?
    Answer this question
    
After reduction, radiographs are repeated to confirm complete reduction and to identify any new fracture that has resulted from the reduction process, or any fracture that was previously obscured by overlap.

    (2008) 68 ESEUJR 1 2-15 



  • Post-operatively, was the patient immobilized? Why is this important?
    Answer this question
    
After reduction of the fracture, there needs to be a period of immobilization to allow the soft tissues to heal.

    (2005) 36 EINJEX 4 90-95 



  • Was physical therapy advised after immobilization? Why is this important?
    Answer this question
    
Studies have shown that positive outcomes are the result of early diagnosis, early treatment, and also on early physical therapy regimes.

    (2005) 36 EINJEX 4 90-95 



  • Were there any signs of neurologic deficit following fracture management? Why is this important?
    Answer this question
    
Radial nerve dysfunction after closed reduction may represent nerve laceration due to reduction maneuver or nerve interposition between fracture fragments.

    (2011) 20 JSAESU 5 833-844 



  • Did the patient develop symptoms of vascular compromise following immobilization? Why is this important?
    Answer this question
    
Damage to the axillary artery is a recognized, complication of proximal humeral fracture. 

    (2006) 20 ECORTH 3 222-233 



  • Did the patient develop compartment syndrome? Why is this important?
    Answer this question
    
Compartment syndrome is caused by swelling and increased pressure in a closed space.

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  • Was there a delay in initiating treatment for the compartment syndrome? Why is this important?
    Answer this question
    
Initial treatment includes splitting a tight cast, removal of occlusive dressing material, and cast padding, all of which contribute to decreasing compartmental pressure.

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  • Did the patient develop non-union in the affected arm after 6 months from the date of injury? Why is this important?
    Answer this question
    
Errors in diagnosis lead to non-unions or mal-unions. The most common error is a missed tuberosity fracture. This error usually results from inadequate radiographic evaluation. Failure to recognize the full extent of the injury frequently results in inappropriate closed treatment or inadequate internal fixation.

    (2000) 31 EORCNA 1 51-61 



  • Did the patient develop mal-union? Why is this important?
    Answer this question
    
Mal-union, non-union, and avascular necrosis, the most common complications of non-operative treatment, result in limited shoulder motion and weakness and can cause persistent disabling pain and shoulder dysfunction.

    (2000) 31 EORCNA 1 51-61