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بعد كسر بالعضد


حالة سريرية

الوصف الكامل Background

A 34-year-old Hispanic male comes in after being involved in a
street fight. He complains of painful and swollen left arm. X ray
shows fracture of midshaft of humerus. The neurovascular
examination is normal in left arm. Closed reduction of facture is
done and arm is kept in hanging cast. One hour later the patient
complains of numbness in the left wrist with marked limitation of
extension at wrist. Which of the following is the most likely
diagnosis at this time?
A.Radial nerve injury.
B.Brachial artery injury.
C.Compartment syndrome.
D.Ulnar nerve injury.
E.Median nerve injury

a.m.a's picture
by
طبيب مقيم

Quote:
shows fracture of midshaft of humerus

A.Radial nerve injury

mbs2380's picture
mbs2380
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طيب لح جرب جاوب بس من هلأ أنا سنة أولى يعني إذا جاوبت غلط فبلا خناقEye-wink

بعتقد الجواب هو A.Radial nerve injury

لأنو

Quote:
limitation of
extension at wrist

يعني يا باسطة الرسغ الكعبرية يا الزندية تعطلوا و التنتين بعصبن العصب الكعبري

يعني وقت صار الكسر بالعضد تأذى العصب الكعبري

بس سؤالي ليش بعد ساعة لحتى بين ؟؟؟؟

Quote:
The neurovascular
examination is normal in left arm
Quote:

و ليش كان هادا الفحص طبيعي؟

the phantom

Quote:
numbness in the left wrist with marked limitation of
extension at wrist
Quote:
shows fracture of midshaft of humerus
number A
the prince of generation's picture
the prince of g...
السنة السادسة


طبعاً الجواب A

بدنا سؤال أصعب

the best's picture
the best
طالب دراسات عليا

Quote:
بدنا سؤال أصعب

here is another easy one:
which artery might be affected in the midshaft fracture????

mbs2380's picture
mbs2380
بعد التخرج


إصابة العصب الكعبري

برافو للجميع وطالب الأولى تحياتي لك لمشاركتك

the-best :معك حق السؤال سهل بس وارد يجي متله

بالنسة لسؤال ليش كان الفحص طبيعي ؟

الأذية هنا ليست بسبب الكسر نفسه بل حصلت أثناء رد الكسر ’خاصة ان كسور جسم العضد الغير متبدلة ترد رد مغلق .

Radial nerve passes through the radial groove, which is on the
posterior surface of humerus.
It is the most commonly injured
nerve in fracture of midshaft of humerus.
Injury can occur at the "
time of fracture due to traction of nerve by the fracture end or after

the reduction of fracture due to impeachment of the radial nerve

during closed reduction as in this patient."
Radial nerve injury
would lead to wrist drop due to marked limitation of extension at
wrist joint
(Choice A).

Educational objective:

Radial nerve is the most commonly injured nerve in association
with fracture of midshaft humerus

a.m.a's picture
a.m.a
طبيب مقيم


which artery might be affected in the midshaft fracture

Quote:
????

brachial artery

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
brachial artery

no........

mbs2380's picture
mbs2380
بعد التخرج


I think radial nerve is accompained by profunda brachii (deep brachial) artery

wee's picture
wee
السنة الخامسة

it is deep brachial artery...which attached to the radial nerve in the radial groove at the inferior surface in the humerus
the prince of generation's picture
the prince of g...
السنة السادسة

Quote:
inferior surface

posteriorEmbarrased

the prince of generation's picture
the prince of g...
السنة السادسة

wee" and "the prince of g" .......u r totally right".........

now I have another q:

Because he was late, a 23 year-old man was running trying to catch up the train ,he grabbed the train,but unfortunately he couldn't get into it ,,so he was dragged by the train -while he was catching it by his hands- for many meters .......then he just let the train go and he fell on the ground.........

he was brought to the ER:
there were many bruises ..........and he was examined and he had the the following:
his (flexor digitorum profundus,flexor carpi ulnaris,interoseous muscles ,thenar and hypothenar muscles were paralysed ......
there was a loss of sensation in the medial part of the left arm,forarm and the hand.
the deep tendon reflex of the biceps was intact,wherase the triceps reflex was absent.
there were also ptosis ,miosis and hydrosis........

what do u think he has ??>?>?>?>

mbs2380's picture
mbs2380
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The question is for first three years student......if u don't know ,search and u will know.........Eye-wink

mbs2380's picture
mbs2380
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the damage at:
radial and ulnar nerve
Quote:
there were also ptosis ,miosis and hydrosis

i do not know what these maens...can you tell me

the prince of generation

the prince of generation's picture
the prince of g...
السنة السادسة

Quote:
The question is for first three years student......if u don't know ,search and u will know.........

it's very good question... so, ppl in the basic area... just think in every symptom alone... then put them all together to get the answer...

Fouad's picture
Fouad
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Quote:
the prince of generation

sorry ,this is the first time that I know this,cuz it is always shown like that,I always wondered how this person( I mean u) know how many dots he must write to sign in.......confusing ha??

O.K ,regarding ur answer, in medicine ,always try to add all the symptoms together and find a connection till u get the final diagnosis.....

Quote:
do not know what these maens...can you tell me

yes I can,but I won't .....u wrote this comment so u have internet,so search for them ,cuz if u search and find the answer I bet that u won't forget them ........

I will just tell u that they are in the face.........

O.k so now try to connect ,and find a link between the symptoms and signs,how can one lesion cause an effect in the face and the arm at the same time.??>?>?

search ,search ,search............and if u give up( and I hope u won't) tell me.........

good luck.......

mbs2380's picture
mbs2380
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Quote:
hydrosis

sorry I meant anhydrosis

mbs2380's picture
mbs2380
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i hope that this answer is correct:
the damage was at the face and the upper limb...
and mainly the nervous system...
so we have to connect between the both...
ok.
Quote:
there were also ptosis ,miosis and anhydrosis

these tell us that the damage at the sympathetic cervical trunks....
and at arm....absolutely it is the Brachial plexus...
and we know that the Brachial plexus takes cervical trunks....
sooooooooooooooo....
he fall maybe at the area between the shoulder and the neck,where Brachial plexus is located...
am i right??

it is no problem about generation for me know..
just at first...it is related to the support on hakeemRolling Eyes

the prince of generation's picture
the prince of g...
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Good Job,really good ..........but I need more......I need the name of the paralysis and also the name of the syndrome that manifested in the face..........

O.K.......

mbs2380's picture
mbs2380
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Quote:
syndrome that manifested in the face..........

Horner Syndrome

Quote:
the name of the paralysis

Embarrased

the prince of generation's picture
the prince of g...
السنة السادسة

Quote:
syndrome that manifested in the face..........

Horner Syndrome

ya,u r right ,u r really doing a great job here............

Quote:
the name of the paralysis

Klumpke....
I finally find it :

read it,please ,it is a similar case

https://www.hakeem-sy.com/main/node/9968

سقى الله تلك الايام....... Crying or Very sad

mbs2380's picture
mbs2380
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شكراً جزيلاً دكتور بسام Very Happy

the prince of generation's picture
the prince of g...
السنة السادسة


you know what ,i think it is a problem in the c7,c8 ,T1,but I did remember that is
Klumpke paralysis coz I studied this paralysis in pediatrics as birth injuries

it is really interesting case
thank you dr.Bassam

the prince of g...:good job ,go on

a.m.a's picture
a.m.a
طبيب مقيم


but I did remember that is"
Klumpke paralysis"

I did not

a.m.a's picture
a.m.a
طبيب مقيم


(sorry ,this is the first time that I know this,cuz it is always shown like that,I always wondered how this person( I mean u) know how many dots he must write to sign in.......confusing ha)

Helwa, I really like it Laughing out loud

yalla, we're waiting 4 the next Q

wee's picture
wee
السنة الخامسة


طيب شو بدي ساوي يعني....
قالولي جماعة التقني غير اسمك بحيث يكون اسم شبيه...
وما كان في غير prince
والمشكلة ما ببحبو هيك لحالو...(راح سبب الاسم الطويل)
والمشكلة التانية في واحد تاني اسمو prince
طيب رضينا بحالنا...
ولا يجوز أن يظهر الاسم كاملاً لأنو عرض الصفحة غير مناسب..
والاسم لازم يكون بسطر واحد...
ولست الوحيد..هناك أيضاً الدكتور سامر سقا أميني مطيريلو نص الاسم..
وفي كائن حي متعدد الخلايا..
بعتقد لازم يكون في حل...
إذا أزعجكم هذا الطرح ...
رجاءً احذفوا تعليقي هذا...أنا أردت أن يسمعوا صوتي.

the prince of generation's picture
the prince of g...
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