The pdf of the article you requested follows this cover page. The incidence is thought to be between 12 and 30 per 100,000 per year. Medical records were analyzed including radiographs, ao fracture type, level of humerus fracture and postoperative radial nerve palsy with its recovery duration. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Classification no universally accepted system for humeral shaft fractures anatomical proximal shaft, middle shaft, or distal shaft. In this article we will cover the middle part, that is the shaft of the humerus bone. Position of fracture had not changed since january 21, when the mobility of arm had been so good that the patient was satisfied and declined further treatment.
Discussion when fixation of fracture shaft humerus is indicated the plate and screw fixation is the most popular than the intramedullary nail fixation in spite of no significant major differences in the term of union rate. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. The diagnosis of a gunshot fracture of the humerus is a potentially very serious injury. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Introduction humeral shaft fractures represent 1%3% of all fractures and 20% of humeral fractures in adults.
If a fracture or fracture repair is stable, then therapy should be started early. The most common fracture pattern identified was a3 type 48. I think most would define successful fracture treatment as a functional union with minimal deformity. Humerus fx orif protocol proximal, midshaft, or distal orif dr. Location proximal, middle, or distal type of fracture line transverse, oblique, spiral, comminuted, or segmental opened or closed status this article focuses on midshaft humerus fractures. F ractures of the humeral shaft account for approximately 3% of all fractures. Peshawar from january 2014 to december 2016 including patients with shaft of humerus fracture who underwent surgery for fixation. Humeral shaft fractures are often the result of highenergy trauma such as a fall from a height or motor vehicle accident in the younger patient or a simple fall in the older adult.
Aug 18, 2019 humerus fractures are generally divided into three types of injuries based on the location of the fracture. Narrated, annotated lecture 2 of 3 on humeral shaft fractures from the ota resident lecture series narrated by saqib rehman, md, from. Humerus shaft fractures acta chirurgiae orthopaedicae et. 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. Aaos modern day management of humeral shaft fractures. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. 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. Sep 23, 2019 sixty humeral shaftfracture patients with a minimum age of 18 years were randomly assigned into two groups. 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. 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. It also includes the hinge of the elbow joint on the bottom. Humeral shaft fracture everything you need to know dr. 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. This is certainly still the contemporary view but there is.
Proximal means it is the end of the bone that is closest to the body. This fracture is commonly seen in adult but in the rare case it may also happen to children. The most useful rehabilitation protocol is the threephase system. Pdf evaluating the outcome of management of humerus shaft. Most humeral shaft fractures unite if left alone in the same room. Fracture site mobility at 6 weeks after humeral shaft fractu. Sep 01, 2016 first, on the head neck of the humerus. As in other upper humerus fractures, early joint motion is. Most fractures of the humeral shaft can be treated nonoperatively with a coaptation splint, hanging arm cast, cuff and collar, or fracture brace.
An open fracture occurs when there is a laceration through the skin that connects to the fracture. Functional bracing of fractures of the shaft of the humerus. The most common site of fracture is at the junction of proximal rd and distal 23rd. Esin, humerus, proximal, shaft, distal, fracture, children, operative, complications. Other injuries, such as those to the chest and other anatomic areas, occur frequently in conjunction with gunshot fractures of the humerus. Physiologically induced motion at the fracture site favors healing of the fracture. Fractures of the shaft of the humerus morphological. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Controversy still exists in the treatment that includes clinical. Sixty humeral shaft fracture patients with a minimum age of 18 years were randomly assigned into two groups.
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. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. Pdf fractures of the humerus shaft often are complicated by radial nerve palsy. Review article elastic stable intramedullary nailing of. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Radial nerve injury after operative management of humerus. Review article management of humeral shaft fractures. The humerus is the long, tubular bone that makes up the upper arm. The top of the arm bone is called the proximal humerus, and the bottom of the bone is called the distal humerus. Humerus fractures in children rarely need reduction and undergo remarkable remodelling.
Treatment of middle third humeral shaft fractures with. A humerus fracture is a break of the humerus bone in the upper arm. Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction. Functional bracing has been widely accepted as the gold standard for treating humeral shaft fractures conservatively. A patients guide to adult humerus shaft fractures anatomy. Pdf humerus shaft fracture complicated by radial nerve palsy. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. One of the nerves that travels from the neck to the hand, the radial nerve, spirals around the humeral shaft lying very close to the bone about. A patients guide to adult humerus shaft fractures compliments of. Adult humerus shaft fractures midwest bone and joint. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Fractures of the humeral shaft with primary radial nerve palsy mdpi.
A humerus fracture is a break in the large bone of your upper arm. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. No classification scheme for humeral shaft fractures. 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. 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. Mid shaft humeral fractures should be followed up in fracture clinic at 1 week. Highenergy trauma, fracture location at the middledistal humerus, and simple transverse fracture or comminuted fracture with butterfly fragment seems to be risk factors for radial nerve transection. Multivariate regression analysis showed that there was an increased risk of palsy of the radial nerve with fractures of the middle or distal shaft table v. Mid shaft humeral fractures, aka humeral shaft fracture or diaphyseal humerus fractures, are a break somewhere in the middle section of the bone. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Proximal humerus fractures third most common fracture only behind hip and distal radius account for about 5% of all fractures courtbrown cm, caesar b. Humeral shaft fracture summary radiology reference. Humeral shaft fractures usually involve the middle one third, resulting from a direct blow or a twisting force, which causes a spiral fracture figure 199. Middle third fractures damage this vessel higher rate of delayed union.
If the fracture is an open fracture also called a compound fracture surgery will be necessary. From ring et al for very distal comminuted fractures type 1 capitellum and lateral trochlea type 2 is a type 1 with comminution of lateral condyle type 3 is a type 2 with comminution behind capitellum with impaction type 4 is a type 3 with trochlea posterior involvement type 5 is a type 4 with fracture of medial condyle. Although they occur in all age groups, a bimodal distribution is noted. An ap and lateral view of the humerus revealed a long spiral fracture of the distal 14 of the humerus with an associated large spiral butterfly fragment. A similar postoperative rehabilitation program was. Ebraheims educational animated video describes fracture fixation of the humerus. The purpose of this study was to assess the influence of injury mechanism, fracture type, and treatment on nerve recovery in patients with humeral. 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. Be wary of nonaccidental injury in toddlers and younger children, particularly with spiral fractures. It can also happen due to sudden and opposite movement of the. Fractures of the shaft of the humerus semantic scholar. A mid shaft humerus fracture is a type of broken arm.
These injuries occur in a bimodal age distribution affecting both young and. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact. Traditionally, humeral shaft fractures have been described according to the following features. There is a high incidence of radial nerve injury associated with humeral shaft fracture, especially. Based on such needs, zuckerman and koval9 indicated surgical treatment in cases of exposed fracture, associated vascular injuries, floating. Operative management of fracture shaft humerus by plate. 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.
Fractures of the humerus are classified based on the location of the fracture and then by the type of fracture. Pdf evaluating the outcome of management of humerus. A similar postoperative rehabilitation program was applied for all subjects for the next 12 months. The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and. The treatment of these fractures is mainly conservative and operative treatment is. Ct scan demonstrated that this fracture was extraarticular. The radial nerve is critical for normal function of the forelimb and wraps around the outer side. Humeral shaft fractures generally occur with significant trauma. However, good surgical outcomes can be achieved with proper patient selection. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis.
The incidence of these fractures has been increasing with the aging population. Humeral shaft fractures pediatric orthopaedic society of. Evaluation of the surgical treatment of humeral shaft. Humerus fx orif protocol proximal, midshaft, or distal orif. 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 represent 3% of all managed fractures and occur with an incidence of per 100,000 per year 1, 2. Humeral shaft fracture radiology reference article. Extraarticular distalthird diaphyseal fractures of the humerus. Humeral shaft fractures account for approximately 3% of all fractures. Humeral shaft fractures journal of shoulder and elbow. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. The overall incidence of fractures of the shaft o f the humerus was 14.
The humerus is the bone in your upper arm, between your shoulder and elbow. Historically, the treatment of choice has been functional bracing. In more elderly people, humerus fracture due to a fall is gene. 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. These fractures are regarded as the domain of nonsurgical management. The drill sleeve also guides the special screwdriver 314. Spiral fractures of the humerus in toddler age and younger are strongly linked with nonaccidental injury. In general, closed humeral shaft fracture associated with radial nerve palsy presents a journal of orthopaedic surgery 25 3 spontaneous. He also underwent statically locked intramedullary nailing of a left femoral shaft fracture. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Jul 15, 2012 mechanism of injury direct trauma is the most common especially mva indirect trauma such as fall on an outstretched hand fracture pattern depends on stress applied compressive proximal or distal humerus bending transverse fracture of the shaft torsional spiral fracture of the shaft torsion and bending oblique fracture usually associated.
Humeral shaft fracture pediatric pediatrics orthobullets. Outcome of humeral shaft fractures lo scalpello journal. Fractures of the humerus comprise approximately 5 % to 8. There are three locations that humerus fractures occur. Pediatric humeral shaft fractures are usually traumatic in nature, although nonaccidental trauma and pathologic lesions can not be overlooked. To regain maximum function after this injury, its important to follow the specific humerus fracture rehabilitation exercises prescribed by your physical therapist. The prognosis for humeral shaft fractures is generally excellent. Jun 10, 2019 a broken upper humerus can make everyday tasks that involve movement of your shoulder very difficult. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral. Humerus fractures functional union acceptable deformity.
This is a retrospective study to evaluate the technique and outcomes of patients with shaft of humerus fractures treated with minimally invasive helical plate technique. Open access minimally invasive helical plating for shaft. Resources on fractures of the shaft of the humerus morphological classification and related topics in orthopaedicsone spaces. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. This technique is suitable for the fixation of fractures involving various parts of the humeral shaft.
Humerus shaft fracture an overview sciencedirect topics. Its especially strong and is capped with the ball of the ballandsocket shoulder joint. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. The overall incidence of humeral fractures was 104. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. The humeral shaft extends distally from the proximal border of the pec toralis major insertion to the supra condylar ridge. Mechanism of injury direct trauma is the most common especially mva indirect trauma such as fall on an outstretched hand fracture pattern depends on stress applied compressive proximal or distal humerus bending transverse fracture of the shaft torsional spiral fracture of the shaft torsion and bending oblique fracture usually associated. Careful history and examination are required to determine the child at risk. It is estimated that these fractures comprise 35% of all fractures in adults. The humerus connects with other bones to form the elbow and the shoulder joints. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles.
Home rehabilitation exercises for a broken upper humerus. Humeral shaft fractures account for about % of all fractures. Fractures of the humerus shaft are usually correctly identified with radiographic images taken from the ap and lateral viewpoints. Check the integrity of the radial nerve with humeral shaft fractures and the axillary nerve with proximal humerus fractures. A comparison of functional bracing and plate fixation. The fracture can happen due to the direct injury or assault on the arm. Humeral fractures can be classified into three types, depending on which part of the bone is broken. Treatment is almost always immobilization due to the high remodeling potential of the pediatric humerus. The humeral shaft is the middle portion of the bone with the shoulder joint at the top end and the elbow joint at the bottom. Sean griffin weeks 14 wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks. Clinical examination for fracture stability was routinely performed on patients by the treating physicians and documented it in the medical record. Humeral shaft and distal humerus fractures are much less common than proximal humerus fractures.
There are several types of humerus fractures, depending on the location of the break. A proximal humerus fracture is when the bone is broken at or near the top, by the shoulder. Evaluating the outcome of management of humerus shaft fracture by medial locking compression plate a prospective study. 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.
This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Patients with this diagnosis are reported to have up to 15% with a major vascular injury and up to 58% with a major nerve injury. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. This is when the proximal humerus is broken into three pieces, and there are then two fracture lines on xray.
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