Proximal humerus fractures are more common than mid shaft fractures. Humeral shaft fracture summary radiology reference. Indications for nonoperative and operative treatment humeral shaft 1. Proximal humerus fracture east sussex healthcare nhs trust. Damage to the radial nerve from a shaft fracture can be identified by an inability to bend the hand backwards or by decreased sensation in the back of the hand.
Humeral shaft fractures have two common mechanisms. Humeral shaft fractures journal of shoulder and elbow. A mid shaft humerus fracture occurs in the middle of the humerus bone and usually does. This usually results in a comminuted fracture or a simple transverse fracture. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. The integra proximal humeral fracture plate system is composed of left and right humeral reconstruction plate implants in two options, gt plate and lp plate. Treatment of the humeral shaft fractures minimally invasive. Begin scar desensitizationmassage at 23 weeks as wound allows. Factors identified as predictive of humeral shaft nonunion include fracture location at the junction of the middle and distal third of the shaft, transverse or short oblique fractures, significant. We have analysed 249 consecutive fractures of the humeral shaft treated over a threeyear period. Acute and chronic humeral shaft fractures in adults emconsulte.
Patients with pd have a high risk of fracture even under low energy because of postural impairments. 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. The prognosis for humeral shaft fractures is generally excellent. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Bony healing occurs usually within 6 to 8 weeks in adults 2. Most humeral shaft fractures unite if left alone in the same room. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Evaluation of the surgical treatment of humeral shaft fractures and. Classification this information is current as of january 22, 2009 reprints and. The shaft of the humerus is triangular to cylindrical in cut section and is compressed anteroposteriorly. Jul 15, 2012 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. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Humeral shaft fracture open reduction and internal fixation.
This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis. Laing 1956 jbjs 38a main nutrient artery enters the humerus at the junction of the middle and distal third, or in the lower part of the middle third. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Modern surgery favors treatment modalities that are minimally invasive, have low morbidity, and provide rapid. In the case of fractures of the proximal humerus, early range of motion is the main aim of treatment. Gartlands classification of supracondylar fracture of humerus. Fractures of the humeral shaft with primary radial nerve palsy mdpi.
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. The incidence of primary lesi on of the radial nerve in association with humeral shaft fracture is quoted at 11. 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. Intramedullary fixation of humeral shaft fractures using an. Surgical interventions to treat humerus shaft fractures. If the fractured segment lies inside the joint then fracture is known as intraarticular fracture and if the fracture segment lies outside the joint or joint capsule then fracture is known as extraarticular fracture. Sometimes this type of fracture is seen in a throwing injury that involves severe muscle contraction. Oct 01, 2003 a variety of treatment options for humeral shaft fractures have been studied and described including closed means, such as functional bracing, and open techniques with internal fixation. 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. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft.
Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Return to normal function and motion may require 3 to 4 months overall goals. Most fractures of the humeral shaft can be treated nonoperatively with a coaptation splint, hanging arm cast, cuff and collar, or fracture brace. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Humeral shaft fractures are the second most common birth fracture. 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. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips. They are most common in children younger than 3 and older than 12 years old. The optilock upper extremity plating system is intended for fixation of fractures and osteotomies. A patients guide to adult humerus shaft fractures compliments of. Fit for a removable sarmientotype humeral fracture brace. Neer, ii and evaluation displaced proximal humeral fractures.
Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. For periarticular fractures of distal humerus see elbow. Good or excellent outcomes are reported in 85% to 95% of patients.
The humeral shaft supplies the attachment for a number of powerful muscles. Surgical technique proximal humeral fracture plate system. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. The gt plate is designed to cover the greater tuberosity and is available in fourhole 91mm and. Humeral shaft fracture open reduction and internal. Fractures resulting from minor trauma may be caused by an occult unicameral bone cyst.
Humeral headsplit fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint. Check the integrity of the radial nerve with humeral shaft fractures and. Plating find, read and cite all the research you need on researchgate. Operative indications failure of closed management poor alignment, intolerance, lack of compliance, body habitus open fractures ipsilateral radius and ulna fractures polytrauma patients brachial plexus palsies pathologic fractures segmental fractures. Nonoperative proximal humeral fracture rehabilitation protocol general principles. These fractures account for approximately 1%5% of all. This normally takes between 612 weeks to unite heal. 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. Although they occur in all age groups, a bimodal distribution is noted.
Proximal humerus fracture book twin cities orthopedics. The antegrade insertion point for the expert humeral nail is located on the extended axis of the central humeral shaft in the lateral view and at the bonecartilage transition of the humeral head in the ap view and not on the greater tuberosity, otherwise the tendon attachment of the supraspinatus will be affected. Other causes include conditions such as cancer in the bone. Splint to be worn full time except for when performing therapy exercises for the. Management of humeral shaft fractures abstract humeral shaft fractures account for approximately 3% of all fractures. The anteromedial surface is the area between the medial border of the humerus to the line drawn as a continuation of the crest of the greater tubercle.
Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. For humeral shaft fractures, techniques include revision to a longstem component, cerclage wiring, plateandscrew fixation, and use of a strut allograft. Periprosthetic humeral fractures in shoulder arthroplasty. Humeral shaft fracture pediatric pediatrics orthobullets. A total of 60 patients with humeral shaft fractures were randomized to undergo surgery with an intramedullary interlocking nail n30 or locking compression plate n30. Treatment of the humeral shaft fractures minimally. This fracture is a hallmark of nonaccidental injury. A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Retrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between december of 2014 and.
Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. The fractures were defined by their ao morphology, position, the age and gender of the patient and the mechanism of injury. The fracture can happen due to the direct injury or assault on the arm. Humeral shaft fractures account for up to 5% of all fractures. The full text of this article is available in pdf format. Ao handbooknonoperative fracture treatment executive editor. Pdf operative treatment of humeral shaft fractures. The gt plate is designed to cover the greater tuberosity and is available in fourhole 91mm and sevenhole 115mm, and tenhole 8mm lengths or sizes. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Fractures involving the attachments of the rotator cuff. A proximal humerus fracture is a break of the upper part of the bone of the arm. Humeral shaft fracture account for nearly 3% of all fractures.
Functional bracing of fractures of the shaft of the humerus. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Humeral shaft fracture radiology reference article. Humeral shaft fractures are frequent, accounting for 1%. The free ends of the suture are brought out external to the shaft. The shoulder is a ball and socket joint and you have fractured just below the ball part. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. However, good surgical outcomes can be achieved with proper patient selection. When treating a periprosthetic humeral fracture operatively, surgical techniques for tuberosity fractures include suture repair, cerclage wiring, or revision to reverse components. The most common site of fracture is at the junction of proximal rd and distal 23rd. Your digital gateway to expertise, education, and innovation. Clinical examination for fracture stability was routinely performed on patients by the treating physicians and documented it in the medical record. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder.
Physiologically induced motion at the fracture site favors healing of the fracture. Humeral shaft fractures musculoskeletal medicine for. Proximal means it is the end of the bone that is closest to the body. Review article management of humeral shaft fractures. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Indirect injuries are likely from a fall on the outstretched hand or from rotational injuries. The incidence is thought to be between 12 and 30 per 100,000 per year. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. 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.
For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. It can also happen due to sudden and opposite movement of the. Usually, the fracture is treated in a splint or sling. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Fractures of the humerus can occur proximally, at the shaft, or distally. Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Humeral shaft fractures constitute only 3% of fractures in children younger than age 16 years. 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. 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. The cause of a humerus fracture is usually physical trauma such as a fall. The treatment of humeral fractures is a complex issue and the source of considerable controversy.
Acute and chronic humeral shaft fractures in adults sciencedirect. Surgical treatment is reserved for specific conditions. Humeral shaft fractures pediatric orthopaedic society of. Treatment of bilateral proximal humeral fracture in patients. Middle third fractures damage this vessel higher rate of delayed union. Be wary of nonaccidental injury in toddlers and younger children, particularly with spiral fractures. Humeral shaft fractures account for 3% of overall fractures. This is an enhanced pdf from the journal of bone and joint surgery. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side.
The system is intended for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus, particularly in osteopenic bone. Pdf on jan 1, 2008, youngkyu kim and others published humeral shaft fracture. Midshaft humerus fracture treatment verywell health. This is the current gold standard method for conservative treatment of humeral shaft 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. Proximal humerus fracture includes the fracture of shaft of the humerus and greater tuberosity. Bony healing occurs usually within 6 to 8 weeks in adults 3. Minimally invasive plating osteosynthesis for middistal. The vast majority of mid shaft humerus fractures heal without surgery, which minimizes complications.
Fracture shaft of ulnar, together with disruption of the proximal radioulnar joint and dislocation of radiocapitallar joint fracture of base of the first metacarpal bone salterharris fracture fracture that involves the epiphyseal plate or growth plate of a bone type i. Trauma specialists should be aware of a range of possible injuries, complications and be confident. Parkinsons disease, proximal humeral fracture, conservative treatment 1. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Extension and internal rotation not performed until 6 weeks 4.
There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. It is estimated that these fractures comprise 35% of all fractures in adults. Radiographic templates of the stem and humeral head are used to preoperatively estimate the implant sizes.
This can be prevented by the early initiation of a rehabilitation program. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Optilock upper extremity plating system proximal humeral. In addition, traditional metaanalyses only directly compared two different interventions. Humeral shaft fracture, humeral anatomy, radial nerve palsy. Open fractures were classified using the gustilo system and softtissue injury. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. 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. They can be classified according to the fracture pattern, location, and tissues damaged.
Left proximal humerus and humeral shaft biopsy left humeral shaft case background information 61yearold lefthand dominant male who had a fall at work resulting in a left proximal humerus fracture with extension into the humeral shaft figure 1. The purpose of this retrospective study was to evaluate the clinical outcome of plate fixation versus intramedullary nailing of midshaft humeral fractures. Twopart fractures of the articular surface and 4part fractures have a high incidence of avascular necrosis of the humeral head. The majority of both proximal and midshaft humerus fractures are nondisplaced and can be treated conservatively nonsurgically. Increase rom while protecting the fracture site you can be slightly more.
Humerus fracture upper arm fracture johns hopkins medicine. Humeral shaft and distal humerus fractures are much less common than proximal humerus fractures. Fracture site mobility at 6 weeks after humeral shaft. The approximate location of the original humeral shaft medial calcar is. Many of these fractures are still being treated conservatively using functional sarmiento bracing or. Humerus shaft fractures acta chirurgiae orthopaedicae et. The drill holes may be placed 2 cm distal to the fracture line if bone is very soft. Includes diaphyseal fractures of distal third of humerus. Humeral shaft fractures account for approximately 3% of all fractures. The pdf of the article you requested follows this cover page. Diaphyseal fractures humerus, femur and tibia orthopaedic trauma for pas and nps ota annual meeting, october 17, 2018 objectives 1.
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