Occupational Therapy Assistant: Treatment Planning

Treatment planning: Fracture at the head of the humerus

Introduction

The humerus is an elongated bone in the forelimb joining the shoulder and the elbow. Humeral head fractures are breakages of humerus near the shoulder. Fractures at the head of the humerus are often associated with aged people especially those who are over sixty years. The fracture can be examined using x-rays. This makes it easier to determine the position and number of fragments and to assess periosteum that is broken or intact. A 3-D scan is used to get clear features of the fracture. The fractures usually hamper effective gliding mechanism, which involves movement of the arm. There are two types of fractures- avulsion fracture and depression fractures. Avulsion fractures show the dislocation of the humerus head towards the varus whereas depression fracture shows a dislocation towards the valgus position (Tey & Tan, 2007). This paper examines a study case involving a seventy-three old woman, called Jane, who had a fracture at the head humerus.

The patient fell from upper stairs to the ground on an outstretched hand and this caused the humeral head fracture. She also suffered other minor injuries, such as bruises, for which she received treatment. The humeral head fracture made the doctor to send her to occupational therapy. Occupational therapy is mainly meant to help the patient improve his or her personal capacities. This therapy may include assistive tools that are used to improve living skills of an individual in his or her environment. In Jane’s case, the occupational therapy evaluated passive range of motion (PROM) with a flexion of twenty degrees, abduction of twenty-five degrees, external and internal rotations of zero degrees, elbow Active Range of Motion (AROM) was forty to one hundred and ten degrees. The patient exhibited a swollen hand and its movement was fifty percent of that one of normal movement. The patient reported presence of persistent pain, which was 3/10 when at rest and 8/10 in PROM. This condition hindered her from playing golf and shuffleboard with her spouse and acquaintances. She is however determined to get well and go on with her lifestyle.

Physical therapy and treatment of Jane’s condition included the assessment of other likely internal injuries. For instance, she was examined for chest wall and lungs injuries. However, no internal injuries were discovered except those that occurred on the arm causing dislocation of the shoulder. In addition, a neurological examination was carried out to test the axillary nerves for sensation around regimental badge area on the muscle of deltoid. The power of the muscle of upper limb was assessed including other peripheral nerves found on the outer parts of the arm (Frankle, 2009).

The fractures were immobilized within a short time to and powerful analgesia given curb further collapsing of humerus. The patient was kept comfortable as much as possible and movements limited. Humeral head injury of the patient did not combine with open fractures in forearm thus there was no need for orthopedic options. Therefore, Jane was treated non-operatively by use of a sling and a shoulder immobilizer. When the patient was examined carefully through an x-ray, shoulder dislocation was discovered. Therefore, internal fixation was carried out to join the humerus and shoulder. There was no need to replace the humeral head since the fracture was not severe but one that can be remedied by immobilizing the upper arm and supporting it using a sling. The patient was examined for a possibility of an interruption of blood flow caused by fracture of the humerus. This is rectified by developing intermedullary nails and minimal invasive locking plates to offer higher capability of fixing fractures that are more complicated without disrupting the supply of blood (Frankle, 2009).

Conclusion

Humeral head fractures can be caused by accidents and falls among others but they often occur in elderly individuals. Treatment should be quick to enable easy fixation of the fractures. For instance, shoulder immobilization and use of sling are used to remedy the condition. The recovery of full operational ability depends on the type of fracture, injury, age of patient and health status. Regaining full movement does not occur in elderly individuals whether surgical or conservative treatment is used. Thus, the goal is to achieve a useful ability of movement. Nevertheless, recovery often takes a minimum of one year whereas fracture combination takes six to eight weeks. Prevention can be done by giving sufficient treatment for patients with a possibility of osteoporosis.

References

Tey, I. K., & Tan, A. H. C. (2007). Posterior fracture-dislocation of the humeral head treated        without the use of metallic implants. Singapore Med Journal 48(4). Retrieved on January        15, 2010 from, http://smj.sma.org.sg/4804/4804cr6.pdf

Frankle, M. (2009). Proximal Humerus Fractures. Florida Orthopedic Institute. Retrieved on       January 15, 2010 from, http://emedicine.medscape.com/article/1261320-overview