a) Determine the position of fragments
b) Determine the best surgical approach
c) Delineate the number of fragments
d) Determine the vascularity of the articular segment
e) Determine whether the fracture has dislocated
2. Implants protruding beyond the medial humeral neck can impinge on which of the following structures:
A) Axillary nerve
B) Axillary vein
C) Radial nerve
D) Axillary artery
E) Musculocutaneous nerve
3. A 34-year-old man involved in a motor vehicle accident sustains a pneumothorax, a closed femur fracture, and closed, displaced fractures of the ipsilateral humerus, radius, and ulna. Management of his femur fracture is open reduction internal fixation. Management of his humerus fracture should consist of:
a) Skeletal traction
b) Closed reduction and plaster immobilization
c) Open reduction and internal fixation of all fractures
d) External fixation of all fractures
e) Internal fixation of the humeral fracture and immobilization of the forearm fracture
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Answers
1.
Answer: D
Explanation:
Neer's four-part classification is designed to determine which fractures will result in avascular necrosis of the articular segment. In a four-part fracture, there is no residual blood supply to the articular segment.
2.
Answer: A
Explanation: With internal rotation, any implant protruding beyond the medial cortex of the humeral neck can impinge on the main trunk of the axillary nerve as it courses behind the humerus.
3.
Answer: C
Explanation: Indications for open reduction and internal fixation of humeral shaft fractures include open fractures, vascular injuries, floating elbow, polytrauma with multiple extremities, closed-head injury, and pathologic fractures.
