You are asked to see a 41-year-old man complaining of right upper arm pain. He was brought in by EMS from a reported single-vehicle crash, in which he was one of approximately 15 people travelling in a van. The patient speaks little to no English, and details of the accident are sketchy. Best as can be ascertained, the vehicle either went out of control or was hit and ran off the road. There were known fatalities at the scene.
Due to language barriers, history is limited. Physical exam shows a middle-aged Asian man who appears quit uncomfortable. He indicates he is hurting in his chest, back, and right arm. His vital signs are normal, and primary survey appears stable, with the patient having multiple abrasions on his face and whole body.
Examination of his right arm shows multiple abrasions with some bruising and swelling, as well as a deformity just above the elbow. The patient is able to slowly move his wrist and fingers. Distal pulses and sensation appear intact. Radiograph of the right humerus is shown. What is your impression?
ANSWER
The radiograph shows an obvious deformity in the distal humerus consistent with an old fracture with chronic malunion. There is no evidence of a superimposed acute fracture.
Once family and interpreters became available, it was elicited that the patient, who is originally from Nepal, did sustain a childhood injury and broke his right arm. No acute intervention was required.
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