humerus-skaft (LH Indholdsside)

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    <Content>
      <HtmlField Name="PageContent"><![CDATA[<h2>Basisoplysninger</h2>
<h3>Definition</h3>
<ul>
    <li>Brud i humerusskaftet (diafysen) er tv&aelig;rg&aring;ende, skr&aring; eller spiralformede</li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Brud i humerus udg&oslash;r ca. 3-5 % af alle brud<a href=" " data-type="journal-reference" data-value="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44" data-value-piped="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M.|Humeral shaft fractures: a review.|J Shoulder Elbow Surg.|2011|20|833-44" data-url="reference-link" title="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9" data-value-piped="Pidhorz L|Acute and chronic humeral shaft fractures in adults.|Orthop Traumatol Surg Res|2015|101|S41-9|25604002" data-url="reference-link" data-pubmedid="25604002" title="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9">2</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33" data-value-piped="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ.|Management of humeral shaft fractures.|J Am Acad Orthop Surg.|2012|20|423-33" data-url="reference-link" title="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33">3</a> </li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Skyldes normalt direkte traumer mod armen eller et kraftigt vrid af overarmen</li>
    <li>Patologiske frakturer kan opst&aring; spontant eller efter minimale traumer</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Patologiske frakturer
    <ul>
        <li>Metastase </li>
        <li>Pagets syndrom</li>
        <li>Knoglecyste </li>
        <li><a href="~/link.aspx?_id=00548CAFEC844B9E8FC871B60BAA152B&amp;_z=z">Osteoporose</a></li>
    </ul>
    </li>
    <li>B&oslash;rnemishandling skal overvejes hos sp&aelig;db&oslash;rn med humerusfraktur</li>
    <li>Vanskelig f&oslash;dsel (obstetrisk humerusfraktur)</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Typisk sygehistorie, kliniske fund og bekr&aelig;ftelse ved r&oslash;ntgen</li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li>Andre humerusfrakturer
    <ul>
        <li><a href="~/link.aspx?_id=753862F79A4B42FD93A25696896A77D5&amp;_z=z">Humerus, capitulum humeri</a> </li>
        <li><a href="~/link.aspx?_id=12AB3D9D3AB34EC48AC68406A4940865&amp;_z=z">Humerus, distalt</a> </li>
        <li><a href="~/link.aspx?_id=4BF55647CDD04C6CAADF5381C7B5F7CA&amp;_z=z">Humerus, proksimalt</a></li>
    </ul>
    </li>
</ul>
<h3>Sygehistorie</h3>
<ul>
    <li>Fald p&aring; strakt arm, direkte slag eller kraftigt vrid</li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>H&aelig;velse, smerte, krepitation og instabilitet </li>
    <li>Neurovaskul&aelig;re funktioner
    <ul>
        <li>Kontroller nervefunktion i arm og h&aring;nd - radialisparese? </li>
        <li>Kontroller pulsen - skade af a. brachialis?</li>
    </ul>
    </li>
</ul>
<h3>Andre unders&oslash;gelser</h3>
<ul>
    <li>R&oslash;ntgen
    <ul>
        <li>Overarm i to planer </li>
    </ul>
    </li>
</ul>
<h3>Hvorn&aring;r skal patienten henvises?</h3>
<ul>
    <li>Ved mistanke om brud</li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]&nbsp;</li>
</ul>
<p>Behandling</p>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Et brud som vokser rigtigt sammen og genoprettelse af en normal funktion </li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>De allerfleste behandles konservativt med pr&aelig;fabrikeret overarmsortose (f.eks. Sarmientobandage)<a href=" " data-type="journal-reference" data-value="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27" data-value-piped="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA|Functional bracing of humeral shaft fractures. A review of clinical studies.|Injury|2010|41|21-27" data-url="reference-link" title="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27">4</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B11218359-73C8-4C6A-8B65-E50A2C92470A%7D&amp;ed=FIELD1567501698&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1567501843&amp;us=sitecore%5Ctobh&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44" data-value-piped="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M.|Humeral shaft fractures: a review.|J Shoulder Elbow Surg.|2011|20|833-44" data-url="reference-link" title="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9" data-value-piped="Pidhorz L|Acute and chronic humeral shaft fractures in adults.|Orthop Traumatol Surg Res|2015|101|S41-9|25604002" data-url="reference-link" data-pubmedid="25604002" title="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9">2</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B11218359-73C8-4C6A-8B65-E50A2C92470A%7D&amp;ed=FIELD1567501698&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1567501843&amp;us=sitecore%5Ctobh&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33" data-value-piped="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ.|Management of humeral shaft fractures.|J Am Acad Orthop Surg.|2012|20|423-33" data-url="reference-link" title="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33">3</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Gosler MW, Testroote M, Morrenhof JW, Janzing HM, Surgical versus non-surgical interventions for treating humeral shaft fractures in adults.. Cochrane Database Syst Rev 2012;1: CD008832" data-value-piped="Gosler MW, Testroote M, Morrenhof JW, Janzing HM|Surgical versus non-surgical interventions for treating humeral shaft fractures in adults.|Cochrane Database Syst Rev|2012|1|CD008832|22258990" data-url="reference-link" data-pubmedid="22258990" title="Gosler MW, Testroote M, Morrenhof JW, Janzing HM, Surgical versus non-surgical interventions for treating humeral shaft fractures in adults.. Cochrane Database Syst Rev 2012;1: CD008832">5</a><br>
    Bandagen udleveres af bandagist efter nogle dages behandling med armslynge, hvor h&aelig;velse kan fortage sig</li>
    <li>Sarmientobandagen tillader bev&aelig;gelser i skulder og albue. Langvarig behandling t&aring;les derfor bedre</li>
    <li>Operativ behandling ved vanskeligere brudtyper, se nedenfor</li>
</ul>
<h3>Konservativ behandling</h3>
<ul>
    <li>Der startes med immobiliserende skinne af f.eks. gips samt en armslynge </li>
    <li>Efter nogle dage, n&aring;r h&aelig;velse er faldet, skiftes til en overarmsortose<a href=" " data-type="journal-reference" data-value="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27" data-value-piped="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA|Functional bracing of humeral shaft fractures. A review of clinical studies.|Injury|2010|41|21-27" data-url="reference-link" title="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27">4</a> </li>
    <li>Der skal gives instruktion i at vedligeholde nogen bev&aelig;gelighed i skulder- og albueled </li>
    <li>De fleste aksefejlstillinger retter sig spontant i l&oslash;bet af 14 dage </li>
    <li>Kontroller
    <ul>
        <li>Normalt kontroller efter 14 dage og 6 uger - og herefter med 3-4 ugers mellemrum til bruddet er helet</li>
    </ul>
    </li>
</ul>
<h3>Operativ behandling<a href=" " data-type="journal-reference" data-value="Updegrove GF, Mourad W, Abboud JA, Humeral shaft fractures. J Shoulder Elbow Surg 2018;27: e87-e97" data-value-piped="Updegrove GF, Mourad W, Abboud JA|Humeral shaft fractures.|J Shoulder Elbow Surg|2018|27|e87-e97|29292035" data-url="reference-link" data-pubmedid="29292035" title="Updegrove GF, Mourad W, Abboud JA, Humeral shaft fractures. J Shoulder Elbow Surg 2018;27: e87-e97">6</a></h3>
<ul>
    <li>Operativ behandling ved:
    <ul>
        <li>&Aring;bne frakturer </li>
        <li>Radialisparese efter reposition, eller ved skade af a. brachialis
        <ul>
            <li>Hvis radialisparesen er tilstede umiddelbart efter skaden, kan frakturen dog behandles konservativt<a href=" " data-type="journal-reference" data-value="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV, Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005;87: 1647-52" data-value-piped="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV|Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review|J Bone Joint Surg Br|2005|87|1647-52" data-url="reference-link" title="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV, Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005;87: 1647-52">7</a> </li>
            <li>Hvis paresen derimod opst&aring;r i behandlingsforl&oslash;bet, er der indikation for operation med eksploration af nerven og osteosyntese</li>
        </ul>
        </li>
        <li>Flerfragmentfrakturer, patologiske frakturer, bilateral humerusfraktur eller multiple frakturer</li>
    </ul>
    </li>
    <li>Metoder
    <ul>
        <li>Marvs&oslash;m, skinnefiksation eller ekstern fiksation har alle fordele og ulemper, og ingen af metoderne er de andre suver&aelig;nt overlegne<a href=" " data-type="journal-reference" data-value="Kurup H, Hossain M, Andrew JG, Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults.. Cochrane Database Syst Rev 2011;: CD005959" data-value-piped="Kurup H, Hossain M, Andrew JG|Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults.|Cochrane Database Syst Rev|2011||CD005959|21678350" data-url="reference-link" data-pubmedid="21678350" title="Kurup H, Hossain M, Andrew JG, Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults.. Cochrane Database Syst Rev 2011;: CD005959">8</a>. Ekstern fiksation anvendes dog prim&aelig;rt til &aring;bne frakturer</li>
    </ul>
    </li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>Evt. optr&aelig;ningsprogram med henblik p&aring; at vedligeholde skulderens og albuens bev&aelig;gelighed</li>
</ul>
<h2>Forl&oslash;b, komplikationer og prognose</h2>
<h3>Komplikationer</h3>
<ul>
    <li>Pseudartrose
    <ul>
        <li>Ses ved frakturer med store bl&oslash;ddelsskader og hos patienter med reduceret knogleheling</li>
    </ul>
    </li>
    <li>Nerveskader
    <ul>
        <li>Er hyppig ved dislocerede frakturer </li>
        <li>Prim&aelig;r radialisskade med droph&aring;nd har god prognose, og kan ses an i op til 1/2 &aring;r<a href=" " data-type="journal-reference" data-value="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV, Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005;87: 1647-52" data-value-piped="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV|Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review|J Bone Joint Surg Br|2005|87|1647-52" data-url="reference-link" title="Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV, Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 2005;87: 1647-52">7</a></li>
    </ul>
    </li>
    <li>Karskade
    <ul>
        <li>Skade af a. brachialis forekommer og kr&aelig;ver hurtig behandling</li>
    </ul>
    </li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Prognosen er som regel god<a href=" " data-type="journal-reference" data-value="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27" data-value-piped="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA|Functional bracing of humeral shaft fractures. A review of clinical studies.|Injury|2010|41|21-27" data-url="reference-link" title="Papasoulis E, Drosos GI, Ververidis AN, Verettas DA, Functional bracing of humeral shaft fractures. A review of clinical studies.. Injury 2010;41: 21-27">4</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B11218359-73C8-4C6A-8B65-E50A2C92470A%7D&amp;ed=FIELD1567501698&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1567501843&amp;us=sitecore%5Ctobh&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44" data-value-piped="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M.|Humeral shaft fractures: a review.|J Shoulder Elbow Surg.|2011|20|833-44" data-url="reference-link" title="Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M., Humeral shaft fractures: a review.. J Shoulder Elbow Surg. 2011;20: 833-44">1</a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9" data-value-piped="Pidhorz L|Acute and chronic humeral shaft fractures in adults.|Orthop Traumatol Surg Res|2015|101|S41-9|25604002" data-url="reference-link" data-pubmedid="25604002" title="Pidhorz L, Acute and chronic humeral shaft fractures in adults.. Orthop Traumatol Surg Res 2015;101: S41-9">2</a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B11218359-73C8-4C6A-8B65-E50A2C92470A%7D&amp;ed=FIELD1567501698&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H1567501843&amp;us=sitecore%5Ctobh&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33" data-value-piped="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ.|Management of humeral shaft fractures.|J Am Acad Orthop Surg.|2012|20|423-33" data-url="reference-link" title="Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ., Management of humeral shaft fractures.. J Am Acad Orthop Surg. 2012;20: 423-33">3</a><br>
    De fleste brud vokser rigtigt sammen
    <ul>
        <li>Selv med en vis vinkling i bruddet bliver funktionen god</li>
    </ul>
    </li>
</ul>
<h2>Patientinformation</h2>
<h3>Hvad findes af skriftlig patientinformation</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=22CF5068296746EB8C016E46DCAC73BD&amp;_z=z">Overarmsbrud i skaftet </a>
    </li>
</ul>
<h2>Illustrationer</h2>
<h3>Tegninger</h3>
<ul>
    <li>
    <a href="~/link.aspx?_id=1A132BD2F0C84A9F80C629A8786C8C3D&amp;_z=z">Oversigt over forskellige brud i humerus</a> </li>
    <li>
    <a href="~/link.aspx?_id=C8DB163E8C4B40B0868EC9407DAF8790&amp;_z=z">Skaftbrud i humerus</a></li>
</ul>]]></HtmlField>
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