Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. All the fractures were in the distal humeral shaft, and butterfly fragments were accompanying in two soldiers. Aaos modern day management of humeral shaft fractures july 10, 2019 director. May 27, 2010 we evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from january 2002 to december 2009. Jan 10, 2017 keywords avulsion fractures casting and immobilization child abusenonaccidental trauma nat distal humerus physeal separation distal femur physeal fracture pediatric hip dislocation pediatric hip fracture humeral shaft fractures lateral condyle fracture medial epicondyle fracture pediatric ankle fractures pediatric forearm fracture pediatric clavicle fracture pediatric distal radius. Modern surgery favors treatment modalities that are minimally invasive.
Good or excellent outcomes are reported in 85% to 95% of patients. Outcome of nonoperative vs operative treatment of humeral. If a fracture or fracture repair is stable, then therapy should be started early. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and. The incidence of humeral shaft fractures has been increasing over time. Surgical interventions to treat humerus shaft fractures. Radial nerve injury has been reported to occur in as many as 18% of humeral shaft fractures. It is defined as a posterolateral humeral head compression fracture and can occur following anterior shoulder dislocation. Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. Review article management of humeral shaft fractures.
Twopart fractures of the articular surface and 4part fractures have. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Minimally invasive plating osteosynthesis for middistal. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. The kirschner wires are locked in the humerus block by small headless pins 3. Humeral shaft fracture radiology reference article. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Reduce fracture anatomically identifyprotect radial nerve other considerations.
Nonunion in fractures of the humeral shaft sciencedirect. This chapter focuses on the clinical presentation, diagnosis, treatment options, and longterm prognosis of humeral shaft fractures utilizing both retrospective and prospective data ranging from 1975 to 2017. However, good surgical outcomes can be achieved with proper patient selection. It is fairly frequently injured with shaft fractures 1216 %.
Historically, the treatment of choice has been functional bracing. Pdf midshaft humeral fracture following a proximal humeral. The drill holes may be placed 2 cm distal to the fracture line if bone is very soft. Proximal humerus fracture book twin cities orthopedics.
Humeral shaft fractures musculoskeletal medicine for. Humeral shaft fractures 1 indications, nonop tx, surgical approaches ota lecture series iii u04a duration. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Injuries combining a humeral head fracturedislocation and a shaft. Fractures of the humeral shaft are at times associated. Humeral nonunion is defined as a fracture with no evidence of healing 24 weeks after injury. The incidence is thought to be between 12 and 30 per 100,000 per year. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. The most useful rehabilitation protocol is the threephase system. Humeral shaft fracture orthopedics medbullets step 23.
The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. The nerve injury is caused by either the initial trauma or during the reduction of the fracture. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. It occurs in 3540% of anterior dislocations and up to 80% of recurrent dislocations. Includes diaphyseal fractures of distal third of humerus. Humeral shaft fracture is a common injury, whether surgery or. The cause of a humerus fracture is usually physical trauma such as a fall.
In more elderly people, humerus fracture due to a fall is generally proximal, sub or. This is the current gold standard method for conservative treatment of humeral shaft fractures. The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, ao type 12a or 12b. Radial nerve palsy 11% of fractures distal proximal higher risk transverse or spiral fractures versus. Humeral shaft fractures secondary to hand grenade throwing. The humerus block itself is fixed to the humerus shaft by a 3. Non op treatment continues to be gold std but outcomes may not be as good as initially thought modern plating vs nailing have similar outcomes, but higher complication rate imn. The humeral shaft is the region just proximal to the supracondylar ridge and immediately distal to the surgical neck. This fracture is a hallmark of nonaccidental injury. One patient who had an open humeral shaft fracture and ipsilateral open monteggia fracture dislocation which required repeat surgery for recurrent dislocation of the radial head. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3.
Other causes include conditions such as cancer in the bone. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Study of incidence and treatment of radial nerve palsy in fracture shaft of humerus amit bhardwaj 1, kye mon min swe 2 1 dr amit bhardwaj. Proximal humeral fractures are common injuries, especially in the.
Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Humeral shaft fractures account for approximately 3% of all fractures. Aaos modern day management of humeral shaft fractures. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to. Minimally invasive plate osteosynthesis mipo of the humeral shaft.
Humeral shaft fractures are defined as fractures in which the major fracture line occurs distal to the insertion of the pectoralis major and proximal to the supracondylar ridge. Nonsurgical management of humeral shaft fractures with functional bracing gained. Sometimes this type of fracture is seen in a throwing injury that involves severe muscle contraction. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Secondary radial nerve palsy was reported in 3 cases, 1 of which had. Vancouver summary twentynine patients with nonunion of the humeral shaft, who were treated in 3 major vancouver hospitals, were studied. She is given appropriate analgesia and placed in a coaptation splint. The humeral shaft supplies the attachment for a number of powerful muscles. We evaluated the treatment of nonunion of humeral shaft fracture with dynamic compression plate from january 2002 to december 2009.
The two main methods of surgery for humeral shaft fractures are plate fixation. Combined threepart humeral anterior fracturedislocation and. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Physiologically induced motion at the fracture site favors healing of the fracture. Nov 20, 2016 fracture line classifications transverse oblique spiral segmentwedge 21.
Radiographic templates of the stem and humeral head are used to preoperatively estimate the implant sizes. Although they occur in all age groups, a bimodal distribution is noted. Most humeral shaft fractures unite if left alone in the same room. Radiographs of her left arm demonstrate a spiral midshaft humeral fracture. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. The free ends of the suture are brought out external to the shaft. Holsteinlewis fracture a spiral fracture of the distal onethird of the humeral shaft 22% incidence associated with neuropraxia of the radial nerve 23. Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Indirect injuries are likely from a fall on the outstretched hand or from rotational injuries.
Case report treatment of 10 year humeral shaft nonunion with. Humeral shaft fractures jennifer bruggers atlanta trauma symposium. A humeral shaft fracture complicated with anterior. This can be prevented by the early initiation of a rehabilitation program. Nonunion of humeral shaft fractures following flexible. Study of incidence and treatment of radial nerve palsy in. Dacron suture through them, are made in the shaft at about 1 cm below the fracture line, and centered about the bicipital groove on the shaft image 14. Results of surgical treatment of nonunion of humeral shaft. It is the most common peripheral nerve injury associated with this. Sep 19, 2014 this is a type of proximal humeral fracture. For periarticular fractures of distal humerus see elbow.
Humeral shaft fractures pediatric orthopaedic society of. This represents a growing public health concern in a climate of cost containment. Proximal means it is the end of the bone that is closest to the body. Fracture line classifications transverse oblique spiral segmentwedge 21. Osteosynthesis of the humeral shaft fractures, with bridge plate. Humeral shaft nonunions with severe osteopenia presents challenges. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury.
For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. In evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important. The incidence of primary lesion of the radial nerve in association with humeral shaft fracture is quoted at 11. Modern surgery favors treatment modalities that are minimally invasive, have low morbidity, and provide rapid. The approximate location of the original humeral shaft medial calcar is. Kokan division of orthopaedic surgery, university of british columbia. Spiral fractures of the distal humeral shaft at the level where the radial nerve exits the posterior compartment through the intramuscular septum are associated with radial nerve palsies. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. This may be recognized by sharp pain associated with fracture motion, andor a fracture gap. Radial nerve injuries are the most common deficit identified in humeral shaft fractures. A divergence of opinion exists in the literature between the values of imn and minimally invasive plating osteosynthesis for the treatment of middistal third humeral shaft fractures.
Those patients with a humeral shaft fracture were identified using diagnostic and procedure codes orthopedic trauma association classification12 19 treated either nonoperatively with fracture. The most common complication of proximal humerus fracture is adhesive capsulitis. Humeral shaft fracture summary radiology reference. Injury to the radial nerve in patients with humeral shaft fractures is the most common nerve lesion complicating fractures of long bones, and historically the holsteinlewis fracture, i. Surgical results of open reduction and plating of humeral. Humeral shaft fractures were identified by the international classification. A radial nerve injury associated with a humeral shaft fracture is an important injury pattern among trauma patients. Fractures of the humerus shaft are relatively common, with an annual. There is an increasing trend in the literature to perform operative fixation of these fractures. Humeral shaft fractures are generally simple fractures of the middiaphysis. One of the most important features of humeral fractures in children is their ability to remodel and heal with minimal to no deformity despite displacement and angulation. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. This usually results in a comminuted fracture or a simple transverse fracture. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures.
Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. In more elderly people, humerus fracture due to a fall is generally proximal, sub or infracapital. Spiral humeral shaft fracture, threepart humeral head fracture. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Twentytwo patients were treated over the study period. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. Simple humeral shaft fractures aoota classification types a and b were reduced by open reduction or closed reduction and fixed with a narrow 4. A series of five cases were presented in which similar fractures of the shaft of the humerus occurred during the hand grenade throwing activity during the military education. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side. Occasionally, the nerve is caught within the fracture site. Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. Keywords avulsion fractures casting and immobilization child abusenonaccidental trauma nat distal humerus physeal separation distal femur physeal fracture pediatric hip dislocation pediatric hip fracture humeral shaft fractures lateral condyle fracture medial epicondyle fracture pediatric ankle fractures pediatric forearm fracture pediatric clavicle fracture pediatric distal radius. It is estimated that these fractures comprise 35% of all fractures in adults. Dec 02, 2017 humeral shaft fractures 1 indications, nonop tx, surgical approaches ota lecture series iii u04a duration.
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