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Ortho Hors D'oeuvres (Prompt):

Patient is a 78 year-old female presenting after a fall from standing onto her left arm. She has tenderness to palpation over the proximal humerus and is neurovascularly intact distally.

X-rays show:

The patient is diagnosed with a midshaft humerus fracture, placed in a sling, and told to follow-up in orthopedic sports clinic. Four days later, the patient comes back to the emergency department complaining of worsening pain and hand weakness. Her repeat x-rays are as follows:


1) What nerve bundle is at highest risk of injury in this fracture pattern?

2) Could this neurologic injury have been prevented with different initial management?

3) What are the next steps in management and what is the prognosis of this patient's fracture healing and future nerve function?

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