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