The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. The holstein lewis fracture was first described by american orthopedic surgeons arthur holstein and gwilym lewis. This humeral shaft fracture has an eponym attached to it, called the holsteinlewis fracture, which is a spiral fracture of the distal one third of the humeral diaphysis that is. The radial nerve is one of the major nerves of the upper limb. The holsteinlewis fracture was first described by american orthopedic surgeons arthur holstein and gwilym lewis. Fractures of the humerus with radialnerve paralysis. Laceration or entrapment is most commonly associated with spiral fractures of the distal of the humerus holsteinlewis fracture and gun shot wounds. A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a. More presentations by andrea catalina sarmiento hgg. Holsteinlewis fracture distal third humeral fracture 18% are associated with radial nerve palsy, particularly if break is between middle and distal thirds of humerus due to direct blow or torsion injury competitors in throwing events ulnar fracture forearm is struck by an object nightstick fracture.
Upper extremity fracture eponyms part 1 article pdf available in international journal of emergency medicine 81. A spiral fracture in the distal third followed by proximal and radial displacement of the distal bone fragment is also known as a holsteinlewis fracture. In our series, patients had distal third, holsteinlewis fracture pattern, with only one of these experiencing nerve palsy. Holstein lewis fractures spiral fractures of the distal third of the. There is a high incidence of radial nerve injury associated with humeral shaft fracture, especially involving the holstein lewis fracture located in the third of the humeral shaft. Humerus shaft fracture associated with traumatic radial nerve palsy. Information and translations of holsteinlewis fracture in the most comprehensive dictionary definitions resource on the web. The holstein lewis humeral shaft fracture constitutes 7. Radial nerve palsy triceps sparing supination lost in the extended elbow flexed allows biceps.
In older people, the most common cause is falling on. The holsteinlewis humeral shaft fracture is well known to most orthopaedic. Fractura lefort 1 pdf one goal of treatment is to restore proper anatomic relationships. Principles in fractures management linkedin slideshare. This allows exploration of the radial nerve during fixation and allows better control of the fragments in the most distal portion of the shaft. Initial plain radiographs depicted a spiral fracture of thedistalthirdofthehumerusfig1,consistentwith a holsteinlewis fracture pattern. At the same time the apex of the distal fragment is moved proximally and radially, lacerating or trapping the radial nerve between the bone fragments.
A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis. In such cases, an open reduction and fixation of the fracture with early nerve exploration is more. It innervates all of the muscles in the extensor compartments of the arm. Symptoms include pain, bruising, and rapidonset swelling. The journal functions as a source of education and information by publishing scientific and clinical articles. Bone fracture academic dictionaries and encyclopedias.
Management of closed fracture with dense radial nerve palsy is observation. Diaphyseal humerus fractures orthopaedic trauma association. Humerus fractures functional union acceptable deformity. Humeral shaft fracture everything you need to know dr. The formerly used fraitur fracture refers to these buttresses, but did not also incorporate the posterior relationship of the zygoma to the sphenoid. Alternative operative exposures of the posterior aspect of the humeral diaphysis with. Radiographic finding is a definite cortical bulge usually occurring at the metaphysis, two to four centimeters from the distal growth plate figure 1. Named after arthur holstein born 1914 and gwylim lewis 1914. Distal third fractures, including holsteinlewis fractures, may be better managed with plate fixation, especially if the fracture extends into the elbow. In treating a fracture, the objectives of the treatment are as follows. The ed management of hlfs includes analgesics and placement of. Humerus shaft fracture complicated by radial nerve. Nvs brachial plexus of the ul runs below the clavicles evaluate it.
Look for skin tenting results in open fracture by perforating the skin or creating a necrotic area. A holsteinlewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. Unlike the proximal third of the humerus, where the radial nerve is separated from bone by triceps brachii muscle fibers, in the distal third of the arm, the radial nerve lies directly over. Operative indications failure of closed management. Initial plain radiographs depicted a spiral fracture of the distal third of the humerus fig 1, consistent with a holsteinlewis fracture pattern.
The resultant neuropraxia to the radial nerve will result in loss of sensation in the radial distribution and a wrist drop deformity. Humerus holstein lewis fracture everything you need to know. A bone fracture can be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, bone cancer, or osteogenesis imperfecta, where the fracture is then. Fraktur monteggia pdf the main goal in treatment of monteggia fractures is the successful reduction of luxation of the radial head and effective retention. Management of common upper limb fractures in adults.
Holstein lewis humerus fracture the american journal of. Management of paediatric humeral shaft fractures and associated. Anterior dislocation of the radial head with fracture of the ulna shaft diaphysis. Radial nerve injury, primary treatment, and outcome. Aspects of radial nerve injury, primary treatment, and outcome the primary aim was to describe. Humerus shaft fracture associated with traumatic radial. The holsteinlewis humeral shaft fracture constitutes 7. Holsteinlewis fracture the holsteinlewis fracture was first described by american orthopedic surgeons arthur holstein and gwilym lewis 5. The ulna bone may also be broken in younger people, these fractures typically occur during sports or a motor vehicle collision. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. A holstein lewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. The injury is a spiral fracture of the distal third of the humerus, typically as a consequence of blunt trauma, with the distal fragment displaced such that the proximal aspect is deviated radially. Several studies have demonstrated that operative management offers no.
Lewis fractures spiral fractures of the distal third of the humeral shaft that often. Trimalleolar fracture bimalleolar fracture potts fracture. Request pdf the holsteinlewis humeral shaft fracture. Injury to the nerve can therefore result in significant. Nonsurgical treatment results in persistent or recurrent dislocations of the distal ulna. Holsteinlewis fracture usually uncountable, plural holsteinlewis fractures a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. Bone fracture project gutenberg selfpublishing ebooks. Segmental fractures holstein lewis type distal fractures large person with varus producing breasts and unbraceable arm. Ray d williams g causes and clinical significance of flushing proximal supracondylar holsteinlewis fracture. Humeral shaft fracture teachmesurgeryteachmesurgery. Holsteinlewis fracture litfl medical eponym library.
Hpi 12 yo boy presents with left elbow pain and a history of an ulna shaft fracture 3 years ago. Aspects of radial nerve injury, primary treatment, and outcome. Holstein lewis fracture is a spiral fracture involving the distal third of the. Archived from the original j october 14, staffing was by emergency medicine residents and boardcertified physicians. The holsteinlewis humeral shaft fracture citeseerx. In addition, the multifragmented subgroup of those rare fractures run the risk of non union after operative treatment as there is soft tissue dissection during surgery. Which direction is the radial head most likely dislocated. Holsteinlewis type distal fractures large person with varus producing breasts and unbraceable arm. Fractures and cartilage injuries sx2 l6 years in practice. Diaphyseal humerus fractures ota course dallas, tx 12017. Definition of holsteinlewis fracture in the definitions. Primary open reduction is the treatment of choice for this injury. In more severe cases, the bone may be broken into several pieces.
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