Musculoskeletal case studies for medical students
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A 30 year old male was assaulted. The fracture was closed. The radial nerve was intact
Initial X ray
AP X ray
Lateral X ray
The 30 year old male who was assaulted. How this was treated, and why.
X ray after treatment
After open reduction and internal fixation.
Post management further view
There is an oblique fracture of the distal end of the humeral shaft.
Discussion of management
Treatment by means of a u slab or hanging cast could lead to union wth acceptable alignmement. There is a high incidence of radial nerve fallout, especially with distal humeral shaft injuries. Function of the radial nerve must alays be checked fo before any treatment is undertaken. The nerve is in grave danger in distal third humeral shaft fractures. Idf a radial nerve has fallout, conservative treatement can still be successful. The nerve damage is usually a axonotmesis and will recover with time. If the fallout is iaterogenic (eg after manipulation), the nerve must be explored. Another indication for exploration would be an open fracture, as the wound needs to be debrided anyway. In this case the surgeon decided to perform ORIF with a plate and screws.
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