ABSTRACT
This chapter presents a case study of a 65-year-old woman who was thrown forward and injured her arm against a metal handrail on the bus. This lady has a spiral proximal humeral shaft fracture. This injury is associated with a rotational type injury such as holding a rail and being thrown forward. The initial management of the patient should be along Advanced Trauma Life Support (ATLS) guidelines with a brief primary survey of the patient to exclude any other injuries including the cervical spine and then a focused exam of the arm, including the joint above and below. A 'U-slab' cast extending in a sugar tong fashion along the humeral shaft length may be used to stabilise the fracture. Whichever method of immobilisation is chosen, adequate analgesia should be given to the patient and procedural sedation by a trained clinician is very useful. Radiographs should be taken post-procedure to check the reduction.
