Thread: Nearly broke my fcuking arm and hand this morning!

Originally Posted by Simon43

Nearly broke my fcuking arm and hand this morning!

there must be a fisting joke in there somewhere

if that photo is real, then it looks like a broken humerus to me.

(Complications

Neurologic and brachial plexus injuries
Neurologic and brachial plexus injuries occur in up to 50% of proximal humerus fractures. Anterior fracture dislocations may injure the axillary nerve. Carefully document any deficits, and monitor them via electromyography. Explore injuries showing no improvement at 3 months. The risk of nerve injury is increased in elderly patients, fractures at the surgical neck, dislocation, blunt trauma with associated hematoma, and in failed open reduction and internal fixation.

Vascular injuries
Injury to the axillary artery may occur in displaced proximal humerus fractures, usually following severe blunt trauma or penetrating trauma. This injury may also be seen with minimally displaced fractures in the elderly patient with arteriosclerosis due to lack of elasticity of the vessel walls. Although it is always important to evaluate the radial pulse, its presence in a case of vascular injury can be misleading because of collateral circulation.

Maintain a high index of suspicion, and proceed to an angiogram when signs of vascular compromise are present. These include expanding hematoma, pallor, paresthesias, pulselessness, unexplained hypotension, bruits, and pulsatile external bleeding. Perform arterial repair emergently when indicated. Failure to recognize and treat these injuries can have catastrophic consequences, including amputation, gangrene, and neurologic compromise (due to compression from the hematoma).

Stiffness or frozen shoulder
Stiffness or frozen shoulder may occur with nonoperative and operative management of proximal humerus fractures. This emphasizes the need for a directed physiotherapy program to maintain mobility during the postfracture and postoperative period. Patients who do not respond to stretching exercises may require operative management, including arthroscopic and/or open release of adhesions. Manipulation under anesthesia should not be performed alone, as risk of refracture exists.

Avascular necrosis
Avascular necrosis is seen in up to 14% of 3-part fractures treated with closed reduction and in up to 34% of 4-part fractures. This complication leads to pain and stiffness in the shoulder and may ultimately require total shoulder arthroplasty.

Malunions
Greater tuberosity malunions occur as a result of the pull of the rotator cuff. Displacement is superior if only the supraspinatus is involved. Union at this site may result in impingement syndrome. Displacement is posterior if the pull is predominately infraspinatus. Union at this site may result in posterior impingement against the glenoid, resulting in decreased external rotation. Indications for surgery include pain and loss of function. Superior tuberosity malunion may be treated with acromioplasty if it is not severe, or tuberosity osteotomy and cuff mobilization. Acromioplasty offers no benefit in posterior malunions, which are treated by tuberosity osteotomy and capsular release. Isolated lesser tuberosity malunions are very rare and will not be discussed.

Surgical neck malunions and malunions of 3-part fractures may be multiplanar in nature with combinations of rotation, flexion/extension, and varus/valgus deformities. Significant angulation may be accepted at the surgical neck. However, there is a concomitant loss of elevation. Additionally, varus malunion places the greater tuberosity in the subacromial space with loss of lateral humeral offset.

Malunion and avascular necrosis of the humeral head in 3- and 4-part fractures usually requires prosthetic replacement. Frequently, posttraumatic arthritis is present on the glenoid surface, and a glenoid component also should be used.

Malunion of a fracture-dislocation may be difficult to treat. The head component may be dislocated anteriorly or posteriorly. Great care must be taken in its mobilization and removal, as there may be adhesion of the neurovascular bundle in the associated scar tissue. Prosthetic replacement usually is necessary.)

i'd let a quack have a look at it.

That's a stock library photo! You don't really think:

- I'd be happy with an arm that shape
- I look like the dork in that photo

Simon

I look like the dork in that photo

having never met you i cant say, but it is not beyond the bounds of possibility.

....... 50ish, not quite past it, greying, black polo shirt (both buttons undone), metal strapped timepiece, exuding the gravitas of an expat hotelier with three or four ex wives to support

exuding the gravitas of an expat hotelier

If my arm was that shape, the last thing I'd be exuding is gravitas....

Come to think of it, there is a passing resemblance to me. Just need to change his attire, drop the glasses, add a smile and more handsome appearance - then you're about there.

Karma for not paying the Burmese hospital bill.

Karma for not paying the Burmese hospital bill.

Bugger! You may be right!

Karma for not paying the Burmese hospital bill.

snigger.

Fucking arms.....
Naturally, know of the fucking hands - goes without saying.

But, a fucking arm must be quite the sight and a handy tool to have around.