Humeral Shaft Fracture

Other Names

Midshaft humerus fracture
Humeral Shaft Fractures
Holstein-Lewis Fracture

Background

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

History
Epidemiology

Account for 3-5% of all fractures^[1]
Bimodal distribution of young males (30s) and elderly females (70s)^[2]

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

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

Risk Factors

Differential Diagnosis

Fractures
- Proximal Humerus Fracture
- Humeral Shaft Fracture
- Clavicle Fracture
- Scapula Fracture
- First Rib Fracture (traumatic or atraumatic)
- Floating Shoulder
Dislocations & Separations
Arthropathies
Muscle & Tendon Injuries
Rotator Cuff
Bursopathies
- Subacromial Bursitis
- Scapulothoracic Bursitis
Ligament Injuries
- Glenoid Labral Tears
Neuropathies
Other
Pediatrics
- Coracoid Avulsion Fracture
- Humeral Head Epiphysiolysis (Little League Shoulder)

Clinical Features

History

History of trauma
Complains of pain, weakness

Physical: Physical Exam Shoulder

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

Evaluation

Radiographs

Standard Radiographs Shoulder
Location (need citation)
- 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

Prognosis and Complications

Prognosis

Needs to be updated

Complications

Nonunion or Malunion
Radial Nerve Injury

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

Created by:

John Kiel on 4 July 2019 08:05:26

Authors:

John Kiel

Last edited:

7 June 2024 19:09:21

Categories:

Trauma | Shoulder | Arm | Fractures | Acute

[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] ttps://www.orthobullets.com/trauma/1016/humeral-shaft-fractures

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