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Rare arm fracture…

April 21, 2015

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Elbow GF1 Elbow GF2 Wrist GF 1 Wrist GF2

This patient presented with arm pain after a fall.  The radiographs obtained showed a distal radius fracture along with a radial head fracture (irregularity and bone fragment seen at the radial head).

I haven’t seen this fracture pattern before.  I’m not sure if it can be classified as an Essex-Lopresti fracture (radial head fracture accompanied by dislocation of the radioulnar joint).  In looking at the radiographs I believe the radioulnar joint is still intact.  However, I’m wondering if the clinical principle of the Essex-Lopresti fracture is maintained:  is there a disruption of the interosseous membrane between the radius and ulna.  This disruption can lead to serious long-term disability including pain, loss of pronation, supination and extension range-of-motion (1).

Has someone out there seen this before?  Any pearls of wisdom regarding this fracture pattern?

Author:  Russell Jones, MD

Imaging Contributor:  Joe Barton, MD

 

References

1.  Essex Lopresti Fracture.  Wheelessonline.com.  Accessed 4/2015.

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Not your ordinary arm fracture…

July 21, 2014

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This patient was shoveling, had sudden onset of forarm pain…

Radius fx 2 radius fx

This is a pathologic fracture from a forearm malignancy.  The patient’s primary malignancy was rectal adenocarcinoma.  This is a rare place for a metastasis.

The mechanism for this patient did not support a broken bone.  However one should keep in mind pathologic fractures when deciding whether to obtain plain films.  Plain films in the ED are quick, inexpensive, and don’t come with significant radiation risks.  I usually argue these points with my residents when discussion about plain film utilization in musculoskeletal pain.

Author:  Russell Jones, MD

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Biker hit by car…

August 12, 2013

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This is a humerus radiograph of a biker who was “clipped” by a car and fell on their side:

Humerus fx 2Humerus fx 1

The image shows a comminuted fracture of the proximal humerus.  It is important, as discussed on past posts, to ensure the axillary nerve is intact as well as the axillary artery.  The other important consideration in this case is obtaining a “Y” or “Axillary” view of the shoulder to make sure you aren’t missing a dislocation either anterior or posterior to the glenoid fossa.

Author:  Russell Jones, MD

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Answer to Humerus fracture…

August 2, 2013

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Humerus fracture

Classically the radial nerve can be damaged by a mid-shaft humerus fracture.  The radial nerve courses in the radial groove on the lateral aspect of the shaft of the humerus.  Other associated nerve injuries with humerus fractures include:

  1. Proximal humerus fracture = axillary nerve
  2. Supracondylar humerus fracture = median nerve
  3. Medial epicondylar humerus fracture = ulnar nerve

It is very important to understand that these are not uniform and other nerves could be damaged with any humerus fracture.  Always test median, ulnar, radial, and axillary nerve function in any upper arm fracture!

Author:  Russell Jones, MD

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Humerus fracture…

July 28, 2013

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Humerus fracture

This is a mid-shaft humerus fracture.  Very common to encounter this in the ED.  What is the most common nerve injured with this type of fracture?

Author:  Russell Jones, MD

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