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Mr Flibble
08-10-2008, 04:34 PM
So I have this guy who had, five years ago, a compund fracture of the upper humerous, where the bone has come through the skin. Given that medical care in his place / time is quite primative ( no plates or pins to hold it all together), how much use would he have from that arm?

I'm assuming he would have some nerve damage, but how extensive? Could he grip with his hands? Raise his arm? Lift stuff ( like a sword?) I realise it depends on where the nerve damage occured and how extensive, but could anyone give me some pointers?

Fenika
08-10-2008, 04:42 PM
Start with 'radial nerve paralysis'

I'll try to give you the nerve break down later, or someone else can jump in. There's a handful of nerves that work their way down the arm. You might also change the location of the damage to suit what long term effects you want. (upper humerous could kill the whole nerve bundle)

Fenika
08-10-2008, 05:05 PM
It's too early for google. I did find this: http://www.ubpn.org/awareness/A2002adultinfo.pdf

Let me try to remember some of this (I'm not on full power atm, but I'll do my best)

Radial nerve damage- full paralysis of the extensors (can't do push ups, can't hold weight up, can't push out. Fingers are curled (b/c the flexors are unopposed), etc. Loss of sensation to parts of the arm (this goes for most nerves so I wont repeat it. You can find maps if you google something like cutaneous nerve loss or w/e)

Ulnar- lower flexors

Median- um, something. Don't typically injure this one alone (I don't think)

Axillary- affects the deltoids

Musculocutaneous- Biceps and other brachii.

It's very common to damage the radial nerve- either upper or lower (like around the elbow). You can also google 'brachial plexus' with or w/o 'nerve damage' or 'loss' (and you can look at each nerve individually, but with upper humerous your person likely has loss of motor function, loss of sensation, and yet fits of pain. Just depends how exactly and what nerves got nailed)

Cheers,
Christina

Mr Flibble
08-10-2008, 05:07 PM
(upper humerous could kill the whole nerve bundle)

I was hoping so :) Poor lad. Any chance it could cause brachial plexopathy? I was thinking he'd have very limited use of his arm and hand - that is he can move them a little, but they wouldn't actually be much use. Would he have continued pain?

ETA: Hehe cross post with your edit. That was exactly what I was after.

Thanks!

Fenika
08-10-2008, 05:18 PM
I believe with brachial nerve damage you are more likely to get a few muscles that work (typically the upper ones, if any) rather than minute movement of all muscles (its possible, but it depends on the damage). So minor use of the hand is unlikely, unless you pick and choose your nerves (so you might have flexor control but not extensors of the fingers and could thus grip something... assuming you can get your fingers around it in the first place)

Personal accounts would help you tons here as far as what ppl can eventually accomplish with 'limited use'

Glad to be of help

Kenzie
08-10-2008, 09:25 PM
One thing that might affect the use of the arm along with the actual nerve damage is muscle atrophy. A wound like that, if not treated like it would be today, would take a very long time to heal and during that time he wouldn't be moving it much at all. The muscles deteriorate surprisingly quickly and take a surprisingly long time to build back up - in an injury as severe as this, it's possible he would never be able to build them back up. I fractured my humerus badly a couple of years ago - not compound, but still quite a crack - and it took me a good year to really use that arm properly again, and even now the muscles are definitely much weaker. Additionally, being a joint and taking into account the likely possibility of it healing crooked and also calcification around the fracture, permanently limited movement is even more likely - again, from my own experience, my range of movement was severely limited for at least a year and permanently limited in some ways - for example I can't straighten that arm above my head anymore and will never be able to.

Fenika
08-10-2008, 11:48 PM
Sorry about your arm Kenzie, but you bring up another good point- is the fracture articular or not (or is it intra-articular? w/e). A crack/split that goes into the joint space does a lot more damage than one that goes across the 'middle' of the bone. If a bone is shattered AND one or more splits goes 'into' the joint, that sucker will never move right again, if at all (exceptional surgery with good healing and physical therapy can save this to some degree)

For additional info: In still growing animals (and this is defined as a critter with an open growth plate, not just one that seems to have stopped getting taller) you can get salter fractures, which is a fancy way to classify how screwed your bone is. These can also be intra-articular or not. They can lead to very crooked bones.

GeorgeK
08-12-2008, 02:12 AM
What do you want the character to be able to do/not do? I have nerve damage and chronic pain in both arms, not from fractures, but if you want some ideas of limitations... Thanks to extensive physical therapy and multiple surgeries my arms are no longer clawed and paralyzed. If I was in the middle ages, I wouldn't have neuroleptic pain meds to take and would probably be drinking my wine undiluted to get through the day. Insomnia is common with chronic pain.Typing is ok as long as it's limited to less than about an hour a day, but holding a pen for that long is simply impossible. My handwriting looks like a first grader's. Some days are worse than others. Anything fast causes a surge in pain, like when you drop something and try to grab it out of the air by reflex. I'm slowly learning to unlearn those reflexes. Things requiring fine dexterity is terrible, like some days needing 2 hands just to eat with a forkand not being able to cut a steak. All my doors have lever handles since I have trouble with knobs. I can't shave and often need help with washing my hair. I use slip on shoes or velcro, since tying laces is painful. At home I go barefoot so I can use my toes to pick things off the floor. Running had to be re-learned to be able to do it without swinging my arms. Gradually some nerves cross wired to fill in the denervated areas, but it was like going from gloves to mittens. Moving an individual finger by itself is simply impossible. Try to move one and a couple to either side move with it.

Mr Flibble
08-12-2008, 02:20 AM
George, how terrible for you. That sounds awful - I hope you have a prospect of improvement.

However, in a purely selfish vein - thanks, that was very helpful.

awatkins
08-12-2008, 02:26 AM
My granddaughter suffered a brachial plexus injury (BPI) during birth that caused significant damage. She can't lift her left arm any higher than her shoulder and can't move it to the side at all. Occasionally her hand and wrist try to rotate inward; physical therapy has helped some, plus the fact that she's one determined little girl.

Hope that gives you a little info to chew on. :)