II. Signs

  1. Evaluate Radial Nerve function

III. Management: Manipulative reduction with local anesthetic

  1. Pitfalls
    1. Avoid distraction of Fracture fragments
  2. Patient positioning
    1. Patient sits on stool, leaning forward
    2. Support wrist to overcome apprehension
    3. Elbow should hang free at 90 degrees flexion
  3. Reduction Technique
    1. Weight of arm alone may reduce Fracture
    2. Gentle traction downward at wrist
    3. Countertraction with a sling around axilla
    4. Assistant holds axilla sling and thumb
  4. Confirm end-to-end apposition
    1. Apply upward pressure on elbow
    2. Telescoping Humerus indicates apposition not secure

IV. Management: Splint Immobilization

  1. U-Shaped splint "Sugar-Tong"
    1. Splint medially from axilla to elbow
    2. Closed end of "U" under elbow
    3. Splint over lateral arm to Shoulder
  2. Ace wrap around splinted arm
  3. May swath by strapping Humerus to chest

V. Prognosis

  1. Heals in 8 to 10 weeks
  2. Heals well with closed reduction (non-operative)

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