Humeral Shaft Fracture

Other Names

• Midshaft humerus fracture
• Humeral Shaft Fractures
• Holstein-Lewis Fracture

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Background

• This page refers to diaphyseal fractures of the Humerus, often called humeral shaft fractures

History
Epidemiology

• Account for 3-5% of all fractures
• Bimodal distribution of young males (30s) and elderly females (70s)

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Introduction

Etiology

• Typically occurs as a result of a direct blow
• Can occur from indirect trauma (i.e. twisting)

Associated Injuries

• Radial Nerve Injury
• Less commonly
  • Ulnar Nerve Injury
  • Median Nerve Injury
  • Brachial Artery Injury

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

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Risk Factors

• Osteoporosis
• Osteopenia

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Differential Diagnosis

• Fractures
  • Proximal Humerus Fracture
  • Humeral Shaft Fracture
  • Clavicle Fracture
  • Scapula Fracture
  • First Rib Fracture (traumatic or atraumatic)
• Dislocations & Separations
  • Acromioclavicular Joint Separation
  • Glenohumeral Dislocation (Acute)
  • Sternoclavicular Joint Dislocation
  • Glenohumeral Instability (Chronic)
• Arthropathies
  • Glenohumeral Arthritis
  • Acromioclavicular Joint Arthritis
• Muscle & Tendon Injuries
  • Pectoralis Major Injuries
  • Pectoralis Minor Injuries
  • Proximal Biceps Tendon Injuries
  • Scapular Dyskinesis
• Rotator Cuff
  • Rotator Cuff Tear
  • Rotator Cuff Tendonitis
  • Calcific Tendinitis of the Rotator Cuff
  • Subcoracoid Impingement Syndrome
• Bursopathies
  • Subacromial Bursitis
  • Scapulothoracic Bursitis
• Ligament Injuries
  • Glenoid Labral Tears
• Neuropathies
  • Suprascapular Nerve Injury
  • Parsonage-Turner Syndrome
  • Quadrilateral Space Syndrome
  • Winged Scapula
• Other
  • Adhesive Capsulitis
  • Paget-Schroetter Syndrome
  • Shoulder Injury Related To Vaccine Administration
  • Distal Clavicle Osteolysis
• Pediatrics
  • Coracoid Avulsion Fracture
  • Humeral Head Epiphysiolysis (Little League Shoulder)

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Clinical Features

History

• History of trauma
• Complains of pain, weakness

Physical: [[Physical Exam Shoulder

• Examine for swelling, bruising, deformity, shortening
• Neurovascular exam is critical

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Evaluation

Radiographs

• Standard Radiographs Shoulder
• Location (need citation)
  • Proximal 1/3: 30%
  • Middle 1/3: 60%
  • Distal 1/3: 10%

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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

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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
  • 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

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Rehab and Return to Play

Rehabilitation

• Needs to be updated

Return to Play

• Needs to be updated

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Prognosis and Complications

Prognosis

• Needs to be updated

Complications

• Nonunion or Malunion
• Radial Nerve Injury

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See Also

Internal

• Physical Exam Shoulder
• Shoulder Anatomy (Main)
• Neck Pain (Main)
• Shoulder Pain (Main)
• Elbow Pain (Main)

External

• Sports Medicine Review Shoulder Pain: https://www.sportsmedreview.com/by-joint/shoulder/

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