Pediatric Humeral Shaft Fracture
synonyms:
Peds Humeral Shaft Fx ICD-9
- 812.21 (closed fracture of humeral shaft)
- 812.31 (open fracture of humeral shaft)
Peds Humeral Shaft Fx Etiology / Epidemiology / Natural History
- May occur from direct blows, falls, MVA, child abuse, birth trauma.
- More common in children under 3y/o and over 12y/o.
Peds Humeral Shaft Fx Anatomy
Peds Humeral Shaft Fx Clinical Evaluation
- Pain and swelling in arm after trauma / fall onto outstretched arm. OFten gross deformity.
- Document NV exam before and after any treatment.
Peds Humeral Shaft Fx Xray / Diagnositc Tests
- A/P and lateral views of the humerus.
Peds Humeral Shaft Fx Classification / Treatment
- Location: proximal 1/3, middle 1/3, distal 1/3. Pattern: spiral oblique, transvers, segmental.
- Acceptable Alignment:
- <5y/o: 70° angulation, 100% displacement.
-5-12y/o: 40-70° angulation
->12y/o: 40° angulation, 50% displacement, bayonet appostion with <2cm shortening is acceptable.
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- Birth Fracture: Splint in extension. Primary complication is internal rotation deformity.
- Acceptable aligment: plaster coaptation splint with a collar and cuff sling. May need sedation for reduction. Document NV exam after splinting.
- Unacceptable alignment: Smooth flexible IM rods (2mm) placed retrograde throught the epicondyles.
- Open fracture or extensive comminution: consider unilateral external fixation or flexible IM nails.
- Holstein-Lewis fracture = short oblique fracture of the distal 1/3 of the humerus noted for potential for radial nerve palsy after closed reduction. (Holstein A, JBJS 1963;45A:1382).
Peds Humeral Shaft Fx Associated Injuries / Differential Diagnosis
- Supracondyle humerus fracture
- Clavicle fracture
- Proximal humeral physeal fracture
- Shoulder dislocation
- Brachial plexus palsy
- Septic shoulder / osteomyelitis
- Child Abuse
Peds Humeral Shaft Fx Complications
- Malunion: Internal rotation deformity can cause limitations in throwing and facial hygiene.
- Radial nerve palsy
- Infection
- Delayed union / nonunion
- Fixation failure
- Compartment Syndrome
- Median/ulnar nerve palsy: uncommon
- Limb length discrepancy: overgrowth of the injury extremity is common, generally <1cm.
- CRPS
- Refracture
Peds Humeral Shaft Fx Follow-up Care
- Follow weekly to ensure alignment is maintained and coaptation splint is fitting properly.
- Generally heals in 6-8 weeks.
- Avoid contact sports until 6 months after injury.
Peds Humeral Shaft Fx Review References
- Beaty JH, ICL 1992;41:369
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