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Humeral Shaft Fracture
From WikiSM
Contents
Other Names
- Midshaft humerus fracture
- Humeral Shaft Fractures
- Holstein-Lewis Fracture
Background
- This page refers to diaphyseal fractures of the Humerus
Epidemiology
- Account for 3-5% of all fractures[1]
- Bimodal distribution of young males (30s) and elderly females (70s)[2]
Pathophysiology
- Typically occurs as a result of a direct blow
- Can occur from indirect trauma (i.e. twisting)
Pathoanatomy
- Humerus acts as an anchor for many major muscle groups
- Insertion: Pectoralis Major, Deltoid, Coracobrachialis
- Origin: Brachialis, Triceps Brachii, Brachioradialis
- Radial Nerve runs along spiral groove
Associated Injuries
Risk Factors
Differential Diagnosis
- Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Dislocations & Separations
- Arthropathies
- Muscle & Tendon Injuries
- Rotator Cuff
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)
Clinical Features
- General: Physical Exam Forearm
- History
- History of trauma
- Complains of pain, weakness
- Physical
- Examine for swelling, bruising, deformity, shortening
- Neurovascular exam is critical
Evaluation
- Radiographs
- Standard Radiographs Shoulder
- Proximal 1/3: 30%
- Middle 1/3: 60%
- Distal 1/3: 10%
Classification
OTA Classification
- Simple
- 12-A1: Spiral
- 12-A2: Oblique (>30°)
- 12-A3: Transverse (<30°)
- Wedge
- 12-A1: Spiral
- 12-A2: Bending
- 12-A3: Fragmented
- Complex
- 12-A1: Spiral
- 12-A2: Segmental
- 12-A3: Irregular
- Holstein-Lewis fracture: spiral fracture of distal 1/3 associated with neuropraxia of the radial nerve
Management
Nonoperative
- Indications
- Most humeral shaft fractures
- < 20° anterior angulation
- < 30° varus/valgus angulation
- < 3 cm shortening
- Contraindications
- Open fracture
- Severe soft tissue injury
- Neurovascular injury
- Immobilization
- Coaptation Splint acutely
- Followed by Humeral Shaft Brace, often referred to as a functional brace
Operative
- Indications[3]
- Open
- Vascular injury
- Nerve injury
- Ipsilateral forearm fracture
- Compartment syndrome
- Periprosthetic
- Relative indications
- Bilateral
- Polytrauma
- Pathologic
- Burns or soft tissue injuries that cant be braced
- Technique
- ORIF with plate
- Closed IM Rod
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Needs to be updated
Complications
- Nonunion
- Malunion
- Radial Nerve Injury
See Also
- Internal
- External
- Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/
References
- ↑ Williams GR, Ramsey ML, Wiesel SW. Operative Techniques in Shoulder and Elbow Surgery. Lippincott Williams & Wilkins. (2010) ISBN:145110264X.
- ↑ Shao YC, Harwood P, Grotz MR et-al. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005;87 (12): 1647-52.
- ↑ https://www.orthobullets.com/trauma/1016/humeral-shaft-fractures