Evaluation

How will my fracture be evaluated?

First aid at the scene of the accident would usually consist of treating shock, applying dressings to wounds if needed and splinting the arm. An ordinary sling will help quite a bit but wrapping a bandage all the way around the chest to bind the arm to the side of the trunk may relieve the pain more completely. The patient should be transferred to the hospital for definitive treatment as soon as possible.

In the Emergency Department the focus will be on making the patient comfortable, ensuring that all injuries have been diagnosed and obtaining an orthopaedic consultation. The nurses and emergency doctors will examine the arm and remove clothing so that the whole arm can be inspected. This may mean that clothes are cut off to prevent further pain or damage to the arm. The examination will pay attention to the site of tenderness, to any deformity of the arm and to the nerve supply and blood supply of the forearm and hand. X-rays will be taken to show the entire humerus from shoulder to elbow. Normally two view will be taken, an anteroposterior (AP) view from front to back and a lateral view from the side.

The orthopaedic evaluation of this injury usually takes place after the diagnosis has been made by the emergency doctor and team. The orthopaedic surgeon will asses the patient's overall medical status and repeat the examination of the arm, paying attention to the nerve and blood supply and any wounds. To form a treatment plan the surgeon will need to review the X-rays and discuss the injury with the patient. This discussion would likely include the patient's work, life style and expectations as well as the options for treatment and the expected outcome. If there are unusual features such as other major medical problems or a pathological fracture other consultants may be called. It is not usually necessary to take further X-rays of the humerus or to do special x-ray tests such as CT scans or MRI.