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Humeral Shaft Fracture

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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

Associated Injuries


Risk Factors


Differential Diagnosis


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


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

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


See Also


References


  1. Williams GR, Ramsey ML, Wiesel SW. Operative Techniques in Shoulder and Elbow Surgery. Lippincott Williams & Wilkins. (2010) ISBN:145110264X.
  2. 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.
  3. https://www.orthobullets.com/trauma/1016/humeral-shaft-fractures
Created by:
John Kiel on 4 July 2019 08:05:26
Authors:
Last edited:
12 November 2020 14:19:21
Categories:
Trauma | Shoulder | Arm | Fractures | Acute