II. Epidemiology
III. Mechanism
- Direct blow to Humerus
- Fall on an outstretched arm
IV. Signs
- Upper arm with deformity
- Evaluate for Compartment Syndrome
- Complete neurovascular exam
- Evaluate for Radial Nerve injury
- Wrist Drop
- Finger extension weakness
- Supination weakness
- Radial Nerve decreased Sensation (e.g. Two Point Discrimination)
V. Imaging
-
Humerus XRay (2 view)
- Consider XRay Shoulder for associated Shoulder Dislocation
- Consider XRay elbow for associated Forearm Fracture
VI. Management: Manipulative reduction with Local Anesthetic
- Pitfalls
- Avoid distraction of Fracture fragments
- Patient positioning
- Patient sits on stool, leaning forward
- Support wrist to overcome apprehension
- Elbow should hang free at 90 degrees flexion
- Reduction Technique
- Confirm end-to-end apposition
- Apply upward pressure on elbow
- Telescoping Humerus indicates apposition not secure
VII. Management: Splint Immobilization
VIII. Management: Surgery Indications
- Open or Comminuted Fracture
- Vascular Injury
- Brachial Plexus Injury
- Ipsilateral Forearm Fracture (floating elbow)
- Compartment Syndrome
IX. Management: Follow-up
- Replace initial splint with Sarmiento Brace within 2 weeks of Fracture
-
Electromyogram Indications
- Indicated in Radial Nerve Palsy or other neurologic deficit
- Perform at 6 weeks after injury
X. Prognosis
- Heals in 8 to 10 weeks
- Heals well with closed reduction (non-operative in >90% of cases)
- Even malunion with mild angulation is typically well tolerated
XI. Complications
- Acute Compartment Syndrome
-
Radial Nerve Injury (Radial Nerve Palsy, 11-20% of Humeral Fractures)
- Travels along spiral groove, in close contact with humeral shaft
- Most Radial Nerve injuries (80%) resolve spontaneously with time
- Consider surgical exploration if failure to resolve
XII. Resources
- Bounds (2020) Humeral Shaft Fractures, Stat Pearls
XIII. References
- Lin (2021) CRit Dec Emerg Med 35(4): 14-5
- Walker (2011) J Shoulder Elbow Surg 20(5): 833-44 +PMID: 21393016 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
ICD10 | S42.3 |
SnomedCT | 208289009, 157208007, 50890004 |
German | Fraktur des Humerusschaftes |
Korean | 위팔뼈 몸통의 골절 |
English | fracture of shaft of humerus, humerus shaft fracture, fracture humerus of shaft, shaft humerus fracture, fracture humerus shaft, shaft of humerus fracture, fracture of humerus shaft, fracture of humerus shaft (diagnosis), Fracture of shaft of humerus, Fracture of shaft of humerus (disorder), fracture; humerus, shaft, humerus; fracture, shaft |
Spanish | fractura de diáfisis de húmero (trastorno), fractura de la diáfisis del húmero, fractura de diáfisis de húmero, fractura de la diáfisis del húmero (trastorno) |
Dutch | fractuur; humerus, schacht, humerus; fractuur, schacht, Fractuur van schacht van humerus |