Última revisão: 13 Feb 2025
Última atualização: 07 Mar 2025
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- pain
- soft tissue swelling
- ecchymosis
- expanding hematoma
- impaired limb function
- inability to bear weight
- point tenderness
- deformity
- guarding
- wound overlying or near site of injury
- signs of vascular injury
- signs of acute compartment syndrome
- hypotension/hypovolemic shock
Detalhes completos
Outros fatores diagnósticos
- altered nerve sensation
- impaired motor function
- bony crepitus
- callus
- reproduction of symptoms in stress fractures of the neck or shaft of the femur
Detalhes completos
Fatores de risco
- direct trauma
- indirect trauma
- osteoporosis (insufficiency fractures)
- chronic renal failure
- diabetes mellitus
- bone tumor (pathologic fractures)
- age >70 years
- age <30 years
- male sex (acute fractures)
- female sex (fatigue and insufficiency fractures)
- prolonged corticosteroid use (insufficiency fractures)
- low BMI (insufficiency fractures)
- history of recent fall (insufficiency fractures)
- prior fracture (insufficiency fractures)
- seizures (proximal humerus fracture)
- long-term bisphosphonate use
Detalhes completos
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- x-ray limb
- CBC, blood typing, and cross-matching (major trauma)
Detalhes completos
Investigações a serem consideradas
- MRI of area of interest without IV contrast
- noncontrast CT of fracture
- whole body bone scan with SPECT or SPECT/CT area of interest
- compartment pressure testing
- Doppler pressure (ankle/brachial systolic pressure index)
- ultrasound duplex scanning
- CT angiogram
- angiography
- dual-energy x-ray absorptiometry bone density scan
- whole-body CT
Detalhes completos
Algoritmo de tratamento
Inicial
involved in high-energy trauma
AGUDA
distal humeral shaft: nonstress
midshaft humeral: nonstress
proximal humeral shaft: nonstress
radial or ulnar shaft: nonstress
upper limb stress fractures
femoral shaft: nonstress
tibia or fibula shaft: nonstress
femoral stress fractures
fibular or posteromedial tibial stress fractures
Colaboradores
Autores
Philip H. Cohen, MD
Clinical Associate Professor of Medicine
UCLA David Geffen School of Medicine
Los Angeles
CA
Declarações
PHC has given lectures for MCE Conferences, a medical education company, and received a stipend/free hotel room during the conference. MCE Conferences accepts no funding from pharmaceutical companies or other outside agencies, and PHC declares that the lectures have no impact on the topic.
Revisores
Robert D. Golden, MD
Chief, Orthopaedic Surgery
MedStar Washington Hospital Center
Regional Chief
Orthopaedic Trauma Surgery
MedStar Orthopaedic Institute
Washington
DC
Declarações
RDG declares that he has no competing interests.
Diagnósticos diferenciais
- Contusion
- Anterior glenohumeral dislocation
- Rotator cuff injury
Mais Diagnósticos diferenciaisDiretrizes
- ACR appropriateness criteria: stress (fatigue-insufficiency) fracture including sacrum excluding other vertebrae
- Fractures (complex): assessment and management
Mais DiretrizesConectar-se ou assinar para acessar todo o BMJ Best Practice
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