Page 301 - Fundamentals of anatomy physiology
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288 Unit 2 Support and Movement
Clinical Case Wrap-Up
8 The Orthopedic Surgeon’s force of the falling child’s weight, the
Nightmare distal humerus can fracture through
this thin bone.
When Caitlyn arrives at the emergency room, she has no pulse
distal to the injury in her arm. Many of the critical nerves and Trying to reduce this fracture in
blood vessels to the forearm and hand run anterior to the hu- an extremely swollen injured elbow
merus through the elbow. These structures have been impaled is like trying to perch one razor blade
by the sharp fractured edge of the humeral shaft. This is a true on top of another inside a watermelon. And the reduction is
surgical emergency. about as stable.
Of all the orthopedic injuries a child can sustain in a “fall on Caitlyn is taken to an operating room where the surgeon
the out stretched hand” (known as a FOOSH injury), a supracondy- performs a closed reduction with the help of x-ray. Her pulse
lar distal humerus fracture is the most difficult to reduce (restore immediately returns. The fracture is held with pins and a long
to anatomical position) and maintain in a reduced position during arm posterior splint is applied.
healing.
1. What skeletal structures are still attached to the distal
Just proximal to the humeral condyle (the trochlea and capit- humeral fracture fragment?
ulum), at the site of the olecranon fossa posteriorly and the radial
fossa anteriorly, the humerus is extremely thin. As the elbow ex- 2. Why would the surgeon want to avoid a circular cast in the imme-
tends, the olecranon is wedged into the olecranon fossa. With the diate post-fracture period and apply a posterior splint instead?
See the blue Answers tab at the back of the book.
