71.17 Fractures of the humerus, radius, and ulna

If a patient has broken his humerus, his radius, and his ulna, concentrate on his radius and ulna; his humerus will probably heal itself. Management depends on the type of humerus fracture he has.

MULTIPLE ARM FRACTURES

If a patient’s humerus fracture is spiral, distraction is less of a problem and it will probably unite, so reduce his forearm fracture and apply a thin long arm cast with his elbow at 90 and his forearm in mid–pronation, so that if rotation is reduced subsequently, his hand will be in the best position. Support the cast in a sling so that its weight does not distract his humerus fracture.

If his humerus fracture is transverse, a long arm cast will probably cause serious distraction. So refer him for open reduction and internal fixation.

If referral is impossible, there are four things you can do: (1) You can risk applying a forearm cast, and support it well in the hope that it will not distract his humerus. (2) You can put a thin (not more than 4 mm) Steinmann pin through his olecranon (Fig. 70-13), and a Kirschner wire through his metacarpals (70.11). When you have done this, you can suspend his arm vertically with his forearm horizontal, supported by a stirrup. (3) You can apply traction, as in Fig. 71-16, but using metacarpal traction instead of skin traction. (4) You can splint his forearm fracture in a light cast in a position of function. Splint his humerus fracture with a light slab on its lateral side, held in place with a crepe bandage. Finally, support his arm in a sling as in A, Fig. 71-1.