Humeral shaft fractures account for % of all fractures and approximately 20% of all humeral fractures. Proximal humeral fractures were discussed in chapter 9. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. The pdf of the article you requested follows this cover page. Isolated ulnar shaft fractures, although seemingly benign, may be complicated by nonunion, radioulnar synostosis, and loss of motion. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Fracture care for the community orthopedist william w. Bone grafting alone as a treatment of a failed union of a femoral shaft fracture cannot be recommended. 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. This represents a growing public health concern in a climate of cost containment. The overall incidence of humeral fractures was 104. The humeral shaft is the region just proximal to the supracondylar ridge and immediately distal to the surgical neck.
Previous studies published concerns over whether this technique had higher complication rates. There is an increasing trend in the literature to perform operative fixation of these fractures. Historically, the treatment of choice has been functional bracing. Distal fractures including intraarticular fractures will be included in chapter 11. Pdf intramedullary nailing of humeral shaft fractures. The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to the midshaft. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. Outcome of nonoperative vs operative treatment of humeral. Fractures of the shaft of the humerus account for 1% to 3% of all fractures and approximately 20% of all fractures involving the bone,4 but little is known about their epidemiology.
Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus 1. May 08, 2012 humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. The humerus is the long bone of the arm and has several different parts to it. It is perhaps the easiest of the major long bones to treat by conservative methods. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6, 7, although this method can present unsatisfactory results, such as. Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. Humeral shaft fractures account for 3% of overall fractures. Intraoperative measurements included blood loss and operative time. Immediate elbow and wrist range of motion rom is essential for successful therapy with a functional fracture brace.
Radius and ulna fractures are more common in men than in women because they are more often to be in motor vehicle accidents or play sports that contribute to getting forearm fractures of the radius and ulna. Humeral shaft fractures extending to the proximal or distal shaft, small or deformed medullary canal or open growth plate. Treatment of the humeral shaft fractures minimally. Secondary radial nerve palsy was reported in 3 cases, 1 of which had reexploration via the posterior approach. Jun 19, 2016 throwing motions, and violent muscle contractions can also cause humeral shaft fractures. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Although they occur in all age groups, a bimodal distribution is noted.
There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age 4. To code a diagnosis of this type, you must use one of the eight child codes of s42. However, good surgical outcomes can be achieved with proper patient selection. Modern concepts of internal fixation of long bone shaft fractures advocate. Humeral shaft fracture radiology reference article.
Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Includes diaphyseal fractures of distal third of humerus. Treatment of the humeral shaft fractures minimally invasive. Although intramedullary nailing imn is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60. If a fracture or fracture repair is stable, then therapy should be started early. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Mechanism of injury there are several unique features of the humerus that. Classification no universally accepted system for humeral shaft fractures anatomical proximal shaft, middle shaft, or distal shaft. It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most frequently, while.
The brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Most humeral shaft fractures unite if left alone in the same room. Humeral shaft fractures were identified by the international classification. The most useful rehabilitation protocol is the threephase system.
The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma. Surgical results of open reduction and plating of humeral. Shaft fracture was classified as simple transverse fracture ao classification a31. The first is the wright and cofield classification system, which is based on the location of the fracture in relation to the tip of the humeral stem. Review article management of humeral shaft fractures. Timing of femoral shaft fracture fixation affects length of hospital. These fractures have an annual incidence from to 14. 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. The concomitant shaft fracture is often comminuted and or open and is thought to absorb the majority of the force decreasing the forces across the neck explaining the less likelihood of displacement versus isolated neck of femur fractures 4. Of a total of 14 neck fractures in a series of 152. The humeral shaft supplies the attachment for a number of powerful muscles.
The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. Humeral shaft fractures are the second most common birth fracture. Unfortunately, there are limited level1 studies to guide the management of isolated ulnar shaft fractures. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. A young adult sustained a closed, shortened fracture of the distal ulnar shaft.
Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. The incidence of humeral shaft fractures has been increasing over time. Based on such needs, zuckerman and koval9 indicated surgical treatment in cases of exposed fracture, associated vascular injuries, floating. Introduction fractures of the proximal humerus or shaft are common. A fracture of the shaft of the humerus is one of the most common bone fractures that people can develop in a car accident. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age.
Humeral shaft fractures pediatric orthopaedic society of. The incidence of osteonecrosis in ipsilateral femoral neck and shaft fractures is also less than that. Minimally invasive plating osteosynthesis for middistal. Fracture of the ipsilateral neck of the femur in shaft nailing. Some people get hurt playing sports while other people just slip and fall. Good or excellent outcomes are reported in 85% to 95% of patients.
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. Humeral shaft fractures humeral shaft fractures account for 3% to 5% of all skeletal fractures. Displacement was 30% of the ulnar diameter at the fracture level on. Displacement was 30% of the ulnar diameter at the fracture level on ap radiogrpah and 60% on the lateral. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Humeral shaft fractures accounts for 35% of all fractures and are associated with great risk of radial nerve injury which is situated in spiral groove in posterior aspect of humerus. 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. It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants 2 with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. A radial shaft fracture with distal radial ulnar joint druj instability is known by its eponym, the galeazzi fracture. Ulnar and radial shaft fractures musculoskeletal medicine.
Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Fractures should be described by location as proximal, middle, distal, or at the junction of the proximal and middle thirds or middle and distal thirds holsteinlewis fracture, see chapter 2. Intramedullary nailing imn is an accepted technique for the treatment of humeral shaft fractures. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Hello, im ed smith, a sacramento bone fracture lawyer. The head of the humerus is the ball and socket joint that makes up the shoulder. 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. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in. A patient with a galeazzi fracture will present not only with pain in the forearm where the radius is broken, but also swelling, tenderness, and pain at the wrist where there is a dislocation of the distal radioulnar joint. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus.
There has been no report on the fracture pattern, complications and surgical outcomes regarding ipsilateral humeral neck and shaft fracture in the literature, nor suggested fracture mechanism. Femoral shaft fractures are an emergency indication and should be promptly stabilized as delayed stabilization is associated with increased morbidity, particularly in the lungs and a longer hospital stay 9. The study included 8 humeral shaft fracture patients. Surgical treatment is reserved for specific conditions.
This fracture is a hallmark of nonaccidental injury. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. Fortythree percent to 69% of fractures involve the mid shaft. Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma rochester, mn 2014 mfmer slide2 disclosures i have no disclosures. It may also result following lowenergy injury or fall in patients with significant osteoporosis or. Comparison of outcome of femoral shaft fracture fixation with. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. Humeral shaft fractures musculoskeletal medicine for. Compression plating versus intramedullary nailing of humeral shaft fracturesa metaanalysis. Surgical options include external fixation, open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and antegrade or retrograde intramedullary nailing. Rehabilitation guidelines for proximal humerus fracture non operative 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. Two classification systems are commonly used for shoulder arthroplasty periprosthetic fractures of the humeral shaft.
A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Functional bracing of fractures of the shaft of the humerus. Humeral shaft fractures with primary radial nerve palsy. Although the fracture line extends into the greater tuberosity, there is no significant displacement or angulation. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Many people have experienced a broken arm due to multiple causes. Intramedullary nailing intramedullary nailing imn is the goldstandard in treating patients with femoral shaft fractures figs 1 and 2. Fractures of the shaft of the humerus semantic scholar.
This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. The incidence is thought to be between 12 and 30 per 100,000 per year. Femoral shaft fractures orthopaedic trauma association. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. Mar 03, 2017 a fracture of the shaft of the humerus is one of the most common bone fractures that people can develop in a car accident.