Complications may include injury to an artery or nerve, and compartment syndrome. With hlfs, the radial nerve can become entrapped or lacerated by bony fragments. A fracture of the normal humerus in a healthy young adult most commonly results from significant direct trauma. 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. Jul 10, 2015 holstein lewis fractures involve the distal third of the humerus where the radial nerve spirals around from the posterior aspect of the humerus with a high incidence of associated radial nerve palsy. Fracture lower limb with fracture shaft humerus for mobilisation 8. The fracture occurs in the distal onethird of the humerus at a point where the radial nerve comes through the lateral intermuscular septum and is in contact with the bone. A 21 year old woman sustained a throwers fracture of the distal humerus and radial nerve palsy while throwing a softball. Humerus fractures functional union acceptable deformity. Throwing sports have become increasingly popular outside of north america and bring with them a novel injury mechanism for clinicians.
Holsteinlewis fracture usually uncountable, plural holsteinlewis fractures a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. The radial nerve originates from the posterior cord of the. Clinical and imaging findings showed a displaced thrower fracture with radial nerve neurapraxia known as holstein lewis fracture prompting the patient to undergo surgery. Holsteinlewis humeral shaft fracture, its association with radial nerve palsy, and the. Fractures of the humerus with radialnerve paralysis. The holsteinlewis fracture was first described by american orthopedic surgeons arthur holstein and gwilym lewis. To ensure usersafety and faster downloads, we have uploaded this. First described by holstein and lewis, it is a fracture of the distal third of the humeral shaft which has a spiral configuration with the distal fragment having proximally migrated and radially angulated. Trauma vivas for the frcs pdf free download direct link. Information and translations of holsteinlewis fracture in the most comprehensive dictionary definitions resource on the web.
The overall outcome regarding fracture healing, radial nerve recovery, and function was very good regardless of the primary treatment modality, that is, operative or nonoperative treatment. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions. Humerus shaft fracture an overview sciencedirect topics. As the radial nerve traverses the distal humerus, it directly contacts the bone. Throwers fracture of the humerus with radial nerve palsy.
Some orthopedic surgeons do not feel as though holstein lewis fractures respond well to functional bracing and should instead undergo. The holstein lewis humeral shaft fracture constitutes 7. The holsteinlewis humeral shaft fracture researchgate. A list of lyrics, artists and songs that contain the term holstein lewis fracture from the website. It is named for arthur holstein born 1914 and gwylim lewis 1914.
A study of humerus shaft fractures treated with dynamic. Controversy still exists in the treatment that includes clinical observation and eventually late surgical exploration or. Aspects of radial nerve injury, primary treatment, and outcome the primary aim was to describe. Holstein lewis fracture is a spiral fracture involving the distal third of the humerus, which causes entrapment of the radial nerve. Humeral shaft fracture everything you need to know dr.
This paper presents seven cases illustrating a humeral fracture syndrome complicated by radialnerve paralysis. Operative indications failure of closed management poor alignment, intolerance, lack of compliance, body habitus open fractures ipsilateral radius and ulna fractures polytrauma patients brachial plexus palsies pathologic fractures segmental fractures. Ct scan demonstrated that this fracture was extraarticular. A holstein lewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. The holstein lewis humeral shaft fracture was associated with a significantly increased risk of acute radial nerve palsy. The same general principles as listed above should be applied. Nabil ebraheim nathan elkins molly university of toledo medical center utmc orthopaedics ut surgeon. Controversy still exists in the treatment that includes clinical observation and eventually late surgical exploration or early surgical exploration. Holstein lewis humerus fracture the american journal of. Humerus shaft fracture complicated by radial nerve. An ap and lateral view of the humerus revealed a long spiral fracture of the distal 14 of the humerus with an associated large spiral butterfly fragment. Topics anterior approach to humerus anterior approach to shoulder arteries of the upper limb blood supply to the humerus classification of proximal humeral fractures condylar fractures distal humeral fractures holstein lewis fractures humerus humeral shaft fracture non union of humeral fractures pediatric humeral frx posterior. The holstein lewis fracture was first described by american orthopedic surgeons arthur holstein and gwilym lewis. The holsteinlewis humeral shaft fracture citeseerx.
Definition of holsteinlewis fracture in the dictionary. Holsteinlewis fractures hlfs are spiral fractures of the distal third of the humeral shaft. Holsteinlewis fracture litfl medical eponym library. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Distal third humeral fractures are also known as holstein lewis fractures. The radial nerve courses along the spiral groove of the humerus and can be damaged with humeral shaft fractures. In that case, the nerve should be explored at the same time that fixation is performed. Jun 15, 2012 holstein lewis fracture is a spiral fracture involving the distal third of the humerus, which causes entrapment of the radial nerve.
I think most would define successful fracture treatment as a functional union with minimal deformity. Lin reported cases with radial nerve entrapment, even in fractures of the midshaft of the humerus, which also had a spiral. Holstein lewis fractures spiral fractures of the distal third of the humeral shaft that often entrap the radial nerve as it traverses the distal. Holstein lewis distal humeral fracture radial nerve palsy wrist drop entrapment impingement brachial plexus posterior cord triceps anconeus extensor muscle group dr. In this article, we are sharing with our audience the genuine pdf download of trauma vivas for the frcs pdf using direct links which can be found at the end of this blog post. Fractures of the humerus shaft often are complicated by radial nerve palsy.
Surgical approaches to distal humerus fractures dr. Holstein lewis humerus fracture, the american journal of. Humerus shaft fracture associated with traumatic radial nerve. Fractures that have additional definition criteria than merely localization often may be classified as subtypes of fractures, such as a holstein lewis fracture being a subtype of a humerus fracture. Intramedullary nailing of humeral shaft fractures antegrade. The recommendation at that time was open exploration of the radial nerve as the large lateral bone spike had an association of nerve laceration and entrapment figure 7. A humerus fracture is a break of the humerus bone in the upper arm. The resultant neuropraxia to the radial nerve will result in loss of sensation in the radial distribution and a wrist drop deformity. Modified anterolateral approach for internal fixation of. Humerus holstein lewis fracture everything you need to know. Wheeless textbook of orthopaedics menu on humeral fractures.
Unlike the proximal third of the humerus, where the radial nerve is separated from bone by. Lewis humeral shaft fracture who underwent open reduction and internal fixation with a plate and screws using the modified anterolateral. Internal trauma, humeral fracture, and radial nerve paralysis. The exception to this rule is if the fracture to the humerus requires fixing in the first instance. Modified anterolateral approach for internal fixation of holstein. A spiral fracture in the distal third followed by proximal and radial displacement of the distal bone fragment is also known as a holstein lewis fracture. Jan 12, 2014 surgical approaches to distal humerus fractures dr. Fractures and dislocationsof the shoulder girdle and elbow. Pdf humerus shaft fracture complicated by radial nerve. The humeral shaft fractures comprehend 3 to 5% of all the skeleton fractures, and are most commonly located on the diaphisys medial third and have a bimodal distribution which affects mainly young men and older women. The age range in the younger group is of 35, the masculine gender predominates 83% and occurs after a high impact trauma. A holsteinlewis fracture is a fracture of the distal third of the humerus resulting in entrapment of the radial nerve. Surgical exposures of the humerus the neurovascular and muscular anatomy about the humerus precludes the use of a truly safe fully extensile approach. Herein we report a 27 years old muscular man presented a spiral fracture of the humerus following a forceful throw of the ball during an amateur throwing challenge.
An anatomical classification may begin with specifying the involved body part, such as the head or arm, followed with more specific localization. If the pts presenting w\ a clinical picture of scaphoid fracture but no radiological signs. Radial nerve palsy following closed unreamed nailing of the. Type of fracture line transverse, oblique, spiral, comminuted, segmental. Holstein and lewis affirm that radial nerve palsies are associated most commonly with spiral fracture 1 fig. Humerus holstein lewis fracture everything you need to. Various common injuries in the shoulder, humerus, and elbow are investigated in this section. This is in accordance with the general literature, where acute indications for surgical exploration of the radial nerve include spiral or oblique fracture patterns in the middle to distal onethird of the humeral shaft with associated radial nerve palsy like the holsteinlewis fracture pattern, open fractures with associated radial nerve. Request pdf the holsteinlewis humeral shaft fracture. Holsteinlewis fracture a spiral fracture of the distal onethird of the humeral shaft commonly associated with neuropraxia of the radial nerve 22% incidence presentation. There may be a decreased ability to move the arm and the person may present holding their elbow.
He is neurovascularly intact in his left arm and leg. Feb 01, 2016 holstein lewis humerus fracture holstein lewis humerus fracture acuna, josie. Named after arthur holstein born 1914 and gwylim lewis 1914. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis, 1963. Bc it might be a hairline fx which doesnt appear until 23 wks when bone resorption happens, so treat as scaphoid fx and repeat xray 2 wks later to r\o fx. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a tricepsavoiding paramuscular technique. These are commonly spiral fractures between the middle and distal thirds of the humeral shaft. 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. This humeral shaft fracture has an eponym attached to it, called the holstein lewis fracture, which is a spiral fracture of the distal one third of the humeral diaphysis that is commonly associated with radial nerve injury. Spiral fractures of the distal humerus, known as holsteinlewis fractures, carry a risk of acute radial nerve palsy in up to 22% of patients 5. The holsteinlewis humeral shaft fracture constitutes 7. Fractures and dislocationsof the shoulder girdle and elbow and fractures of the humerus. Algorithms have been proposed to provide recommendations with regard to management of the injuries.
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