Spiral fractures of the humerus in infants and toddlers are strongly linked with nonaccidental injury. Humeral shaft fractures account for % of all fractures and approximately 20% of all humeral fractures. A proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and. Plate fixation remains the most used fixation method, although closed humeral nailing is considered an alternative treatment with successful. Functional bracing of fractures of the shaft of the humerus. Humeral shaft fracture everything you need to know dr. Eight 16% developed radial nerve palsy after surgery. Pdf nonoperative treatment of humeral shaft fractures. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. The intramedullary rod is commonly used to treat humeral shaft fractures. Surgical treatment is reserved for specific conditions.
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 brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Methods and analysis we will conduct an rct to compare the effectiveness and costeffectiveness of surgical and conservative treatment of humeral shaft fractures. The incidence is thought to be between 12 and 30 per 100,000 per year. This, however, is not the case with a compact shaft bone. Humeral shaft diaphysis can fracture following injury to the arm due to a direct fall or blow, automobile injury, gun shot wound, missile injury, and rarely, due to ballthrowing injuries. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury.
Case report humeral shaft fracture treatment in the elite. Davis, 1 hoanganhho, 2 andjanfronek 3 stetson powell orthopaedics and sports medicine,s. Humeral shaftfractures conservative treatment 90% of humeral shaft fractures heal with nonsurgical management 20degrees of anterior angulation, 30 degrees of varus angulation and up to 3 cm of shortening are acceptable most treatment begins with application of a coaptation spint or a hanging arm cast followed by placement of a fracture brace. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Surgical treatment of humeral shaft fractures can be performed in three ways. The shoulder serves as a connection between the chest and arm. It is estimated that these fractures comprise 35% of all fractures in adults.
Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. Humeral shaft fractures pediatric orthopaedic society of. Treatment of the humeral shaft fractures pubmed central pmc. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Treatment of the humeral shaft fractures minimally. Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. For periarticular fractures of distal humerus see elbow. Adult humeral shaft fractures are associated with primary radial nerve palsy in up to 18% of cases. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures.
Humeral shaft fractures represent approximately 3% of all longbone fractures and have historically been treated successfully in a nonoperative way, but surgical management is indicated in several conditions. All the fractures were in the distal humeral shaft, and butterfly fragments were accompanying in two soldiers. The vast majority of mid shaft humerus fractures heal without surgery, which minimizes complications. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis, 1963. If you or a loved one has been injured in a traumatic accident, please call me at 916 9216400 or 800 4045400 for friendly and free advice.
Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures. The goal of treatment of humeral shaft fractures is to establish union with an. Humerus shaft fractures acta chirurgiae orthopaedicae et. Humerus shaft fracture an overview sciencedirect topics. A unique application of flexible intramedullary nailing christophers.
Midshaft humerus fracture treatment verywell health. Although fractures the clavicle collarbone and proximal portion of the humerus are more common, humeral shaft fractures occur in frequency and may be associated with pain and deformity. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. Proximal humerus fracture book twin cities orthopedics. Shaft fracture was classified as simple transverse fracture ao classification a31.
Case report humeral shaft fracture treatment in the elite throwing athlete. All the fractures healed without any clinical complications with conservative treatment. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Conservative management of fracture shaft of humerus with functional brace is effective mode of treatment. In the early nineties however, intramedullary devices. Ao handbooknonoperative fracture treatment executive editor. Outcome in the conservative management of shaft of humerus. Outcome after treatment of humeral shaft fractures. Suspect pathological fracture if any of the following features are present. For many years, plating has proved to be a reliable method for the fixation of fractures of the humeral shaft. Good or excellent outcomes are reported in 85% to 95% of patients. Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately.
Outcome of humeral shaft fractures lo scalpello journal. See stress fractures of the humeral shaft and proximal humeral fractures in adults. Twohundred thirteen adult patients with a humeral shaft fracture who satisfied inclusion criteria were treated at 2 level 1 trauma centers with either a functional brace nonoperative treatment. Fractures of the humeral shaft with primary radial nerve palsy mdpi. Usually, the fracture is treated in a splint or sling. Introduction fractures of the proximal humerus or shaft are common. Immediate elbow and wrist range of motion rom is essential for successful therapy with a functional. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6,7, although this method can present unsatisfactory results, such as, nonunion and. Functional treatment of closed humeral shaft fractures. Humeral shaft fractures journal of shoulder and elbow surgery. The treatment of a humeral shaft fracture with function al bracing is a stepwise process. Patients and methods 125 71 women patients with 126 humeral shaft frac tures were treated using antegrade intramedullary nailing at oulu university hospital in 19871997. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am.
Sep 19, 2014 the humerus is a relatively common site of pathological fracture. Humeral shaft fractures musculoskeletal medicine for. Modern results of functional bracing of humeral shaft. The pdf of the article you requested follows this cover page. No matter the fracture or treatment type, a broken humeral shaft is a major, painful injury that takes a good deal of time and provider help to recover from. Fortunately, most fractures of the humeral shaft respond to treatment without surgery. The fracture can happen due to the direct injury or assault on the arm. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Aug 07, 20 humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Humeral shaft fractures secondary to hand grenade throwing. The most common site of fracture is at the junction of proximal rd and distal 23rd.
A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be used for initial management of the fracture. The treatment of such cases must be different from the initial treatment. It can also happen due to sudden and opposite movement of the arm against the violent contraction of the muscle. Treatment of the humeral shaft fractures is usually nonoperative with a coaptation splint for 10 weeks followed by a functional brace. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Review article management of humeral shaft fractures. A fracture be tween the superior border of the pectoralis major. This phenomenon has been seldom reported in the literature 1. Limb swelling predating fracture, or marked post fracture swelling.
Complications of surgical treatment of humeral shaft fractures. Approximately 10% of all long bone fractures occur in the humerus. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Radial nerve injury after operative management of humerus. Pdf plate and screw fixation psf has always been the more common surgical treatment of humeral shaft fractures. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. A humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries i. Dcp remains the best treatment for unstable fractures of the shaft of the humerus. Based on such needs, zuckerman and koval9 indicated surgical treatment in cases of exposed fracture, associated vascular injuries, floating. Proximal means it is the end of the bone that is closest to the body. A humeral shaft fracture results in a nonunion in less than 10% of cases, regardless of the technique used. Treatment of middle third humeral shaft fractures with. Many still regard nonoperative management as the standard of care.
Keep the coding pain to a minimum by following this expert humeral shaft fracture repair coding advice. Management of humeral shaft fractures abstract humeral shaft fractures account for approximately 3% of all fractures. 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. The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to the midshaft. These fractures have an annual incidence from to 14. Sixty three patients underwent surgery for shaft of humerus fracture, 14 had radial nerve palsy before surgery. Humeral shaft fracture pediatric pediatrics orthobullets. Includes diaphyseal fractures of distal third of humerus. Humerus fracture upper arm fracture johns hopkins medicine. The recommendation at that time was open exploration of the radial nerve as the large lateral bone spike had an association of nerve laceration and entrapment figure 7. The most common treatment for a humeral shaft fracture is called a fracture brace, often referred to as a sarmiento brace, named after the physician who popularized this treatment method. A total of 344 fractures 29% ultimately underwent surgical intervention.
The results of this treatment were excellent, in comparison to what little data are available describing treatment of open humeral shaft fractures with either intermedullary nails or with external fixation. Fractures of the humeral shaft are common injuries with multiple management strategies. Evaluation of the surgical treatment of humeral shaft fractures and. Although there are numerous randomized clinical trials and metaanalyses that have attempted to guide surgeons, there is little evidence and no consensus as to the most suitable treatment. Your digital gateway to expertise, education, and innovation. Fractures of the humeral shaft with primary radial nerve. Dec 21, 2004 we treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately after injury. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1,2 and for 20% of all humeral fractures. Open reduction and internal fixation of humeral shaft. The humerus is the largest bone in the upper extremity. The risk factor is ao type a fracture 61% and middle third of humeral shaft fracture 63 %, with incidence of palsy to be 20% and 19% respectively.
Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Nonoperative treatment with functional bracing has been regarded as the golden standard for treatment of closed humeral shaft fractures with studies reporting a high overall healing rate and an acceptable functional outcome. At injury, the upper extremity is stabilized with an above elbow hanging. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. Introduction fractures of the humeral shaft account for 1% to 6% of all fractures. It is the third most common fracture that occurs in. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. This fracture is a hallmark of nonaccidental injury. The humeral shaft supplies the attachment for a number of powerful muscles.62 927 207 1099 1195 1292 518 67 590 358 295 45 1357 477 1358 1073 736 1362 893 1181 1037 982 373 1163 55 1565 243 789 421 820 88 280 757 774 1203 427 173