The four segments are the anatomic neck, the surgical neck, and the two tuberosities (greater and lesser). One part: minimal angulation (less than 45 degrees) and minimal displacement (less than 1 cm) of the fracture fragments. Any of the four portions of the proximal humerus may be fractured. Neer two-part fractures: three nondisplaced and one displaced fracture fragment. Neer three-part fractures are those with two displaced and two nondisplaced fracture fragments. The lesser or greater tuberosity must be involved.
Neer four-part fractures are those in which three fracture fragments are displaced. Avascular necrosis is common with these types of fractures. FAT PAD SIGN Fat pad sign, soft tissue swelling with elevation and displacement of the anterior intracapsular fat pads in the elbow. Any intra-articular process that is associated with a mass or fluid may produce this sign, but its presence should raise the suspicion of a fracture in persons with elbow injuries effusion, haemarthrosis or synovitis
Ant fat pads may be normal. POST fat pad always abnormal! RADIOCAPITELLAR LINE The radiocapitellar line refers to a line extending through the longitudinal axis of the radius on a lateral projection. This line should pass through the centre of the capitellum regardless of the degree of elbow flexion. If it does not, dislocation of the elbow or of the radial head should be suspected.
ANTERIOR HUMERAL LINE The anterior humeral line is drawn along the anterior aspect of the humeral shaft on the lateral radiograph. This line passes through the middle one third of the capitellum in bones that are not injured. Only true lateral views should be used to assess this line. A supracondylar fracture changes the anterior humeral line as it passes through the anterior one third or entirely anterior to the capitellum (Figure 10).
DoseAdvantagesCautionsEtomidate0.3 mg/kgGood for low blood pressure; okay in hypovolemia Nausea and vomiting on emergenceKetamine1.5 mg/kgGood for low blood pressure, hypovolemia; good in asthmaCaution in elevated intracranial pressure or heart diseasePropofol2 – 2.5 mg/kgRapid onset and recoveryCaution if hypovolemic or risk of hypotensionThiopental mg/kgMultiple drug interactions; caution if hypovolemic or risk of hypotension Administer a precalculated dose of a paralytic agent.
Dose Characteristics Cautions Succinylcholine1 – 1.5 mg/kgRapid onset, rapid recovery; fasciculationContraindicated in hyperkalemia, crush injury, renal failure, extensive burns, elevated intracranial or intraocular pressureRocuronium0.6 – 1.2 mg/kgNo fasciculationLonger acting-may be problematic if intubation attempt failsVecuronium0.08 – 0.1 mg/kgAtracurium0.4 – 0.5 mg/kg: an abnormal heart rhythm marked by the occurrence of three distinct sounds in each heartbeat like the sound of a galloping horse S3 is the sound of the blood rushing into the ventricle and striking the muscular wall as the ventricle fills passively in relaxation after the pumping stroke is finished. S4 is the thump made by the contraction of the atria Suggests CARDIAC FAILURE, Left Ventricular dysfunction, elevated bNP, LVEF < 50%, Primary valvular disease with elevated filling pressures.