You are here

Humeral Shaft Fracture S42.399A 812.21

synonyms:

 

Humeral Shaft Fx ICD-10

A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

 

Humeral Shaft Fx ICD-9

  • 812.21(fracture of shaft of humerus, closed)
  • 812.31(fracture of shaft of humerus, open)

Humeral Shaft Fx Etiology / Epidemiology / Natural History

  • Uncommon, 3% of all fractures

Humeral Shaft Fx Anatomy

  • Musculocutaneous N pierces coracobrachialis 5-8cm distal to coracoid, supplies biceps,coracobrachialis & bracialis
  • See also Arm anatomy.

Humeral Shaft Fx Clinical Evaluation

  • Pain, swelling, deformity of arm.
  • Crepitus and motion at fracture site.
  • Document neurovascular exam, especially radial nerve.

Humeral Shaft Fx Xray / Diagnositc Tests

  • A/P and lateral views of the humerus generally clearly demonstrate fracture.
  • Consider shoulder and elbow films if there is any concern for intraarticular extension.
  • MRI /CT generally not needed.

Humeral Shaft Fx Classification / Treatment

  • AO classification
  • Majority treated non-surgically-hanging arm cast, functional brace(Sarmiento), coaptation splint.  Hanging arm cast is not recommended for transverse fractures due to potential for fracture distraction.
  • ACCEPTABLE REDUCTION =20° anterior angulation, 30° varus, 15° malrotation, 3cm shortening
  • Functional bracing =96-100% union, brace should be put on with arm relaxed and hanging at side, pendulum exercises should be begun immediately. Hand/wrist exercises aid in decreasing swelling.  Brace must be adjusted as swelling subsides to maintain compression.  Only 2% of fx heal with deformities >25 degrees .  Xrays should be taken when brace placed, 1 wk, and monthly thereafter.  Overall healing takes 11.5wks.  Closed fractures @9.5wks, open fxs @14wks.  5.8% open fx will have nonunion, 1.5% closed fx's. (Sarmiento A JBJS 2000;82A:478) (Koch PP, JSES 2002;11:143). Bracing is contraindicated in patients with ipsilateral brachial plexus palsy. (Brian WW, JBJS 1990;72A:1208).
  • Operative indication =multi trauma, floating shoulder, floating elbow, bilateral, nonunion, open, vascular injury, neurologic injury, obesity, pathologic fx, segmental, plexus injury, progressive radial N palsy, distal intraarticular fx. Low-velocity GSW is not an indication.
  • Humeral Shaft ORIF: screws should be placed in different planes because osteons of humerus are in creating stress riser like splitting log
  • ORIF vs IM nail: ORIF has 90% risk reduction for shoulder impingement symptoms and a 75% risk reduction for reoperation. No difference in infection rate, nonunion rate, and radial nerve palsy.
  • Intramedullary nail. (Bhandari M, Acta Orthop. 2006;77(2):279-84)
  • Humeral Shaft External fixation
  • Radial nerve palsy: exploration of radial nerve palsy in closed fractures is not recommended. Radial nerve transection is associated with open fractures, but direct repair has not shown good functional outcomes. (RingD, J Hand Surg 2004;29A:144).

Humeral Shaft Fx Associated Injuries / Differential Diagnosis

  • Radial nerve palsy=pts with closed fx with radial nerve injury should be treated with fracture bracing, cock-up wrist splint and observation of radial nerve with delayed exploration at 3-4 months in there are no signs of return.  (Pollak EH, JBJS 63A:239;1981). Transection most commonly occurs with spiral oblique fx throught the distal 1/3.  Neuropraxia commonly seen with middle and distal 1/3 fx’s (Holstein A, Lewis GB, JBJS 1963:45A;1382)
  • Radial nerve transection: associated with poor results even with repair (RingD, J Hand Surg 2004;29A:144).
  • Brachial artery injury
  • Proximal humerus fracture
  • Distal humerus fracture

Humeral Shaft Fx Complications

  • delayed union = failure to unite in 2-3 months
  • nonunion 4-6 months
  • malunion
  • Radial nerve palsy-most recover in 3-4 months, pts should be placed in cock-up wrist splint, given thumb abduction and finger/wrist extension exercises to avoid contracture.  EMG at 6 wks if no signs of recovery.  Brachioradialis should be first muscle to return.  11.1% of closed fx have associated Radial nerve palsy, 0.2% in closed fx's fail to recover.  18% open fx. 60% have nerve entrapped in fx. (Bostman O, Acta Orthop Scand 1986;57:316) . (Shaz JJ, Bhatti NA: CORR 1983;172:171. (Holstein A JBJS 1963;458:1382).

Humeral Shaft Fx Follow-up Care

  • Non-op: posterior splint / coaptation splint.
  • Post-op: Posterior splint, NWB.
  • 7-10 Days: Remove splint, begin passive shoulder and elbow ROM. Stress elbow ROM. Place in Humeral fracture brace for non-op patients.
  • 6 Weeks: Begin strengthening exercises provided fracture union is evident on xray.
  • 3 Months: Ensure full restoration of shoulder and elbow ROM. Consider bone stimulator if union is delayed. Sport specific rehab.
  • 6 Months: return to full activities / sport.
  • 1Yr: Follow-up xrays, assess outcomes.
  • Immediate weight bearing on a plated humerus fx with the use of crutches of a walker has been shown to safe. (Tingstad, J Trauma 2000;49:278).
  • Shoulder Outcome measures.
  • Elbow Outcome measures.

Humeral Shaft Fx Review References

  • Carroll EA, JAAOS 2012;20:423
  • Rockwood and Green's Fractures in Adults 6th ed, 2006
  • Farragos AF, Schemitsch EH, McKee MD: Complications of intramedullary nailing for fractures of the humeral shaft: A review. J Orthop Trauma 1999;13:258-267.
  • Zagorski JB, Latta LL, Zych GA, et al: Diaphyseal fractures of the humerus: Treatment with prefabricated braces.  J Bone Joint Surg 1988;70A:607-610.
  • Healy WL, White GM, Mick CA, et al: Nonunion of the humeral shaft.  Clin Orthop 1987;219:206-213.
  • Dabezies EJ, Banta CJ II, Murphy CP, et al: Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries.  J Orthop Trauma 1992;6:10-13.
  • Epps CH Jr: Nonunion of the humerus, in Bassett FH III (ed): Instructional Course Lectures XXXVII. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1988, pp 161-166
  • Gerwin, Michelle, JBJS 1996;78A:1690
  • Levy JC, JOT 2005;19:43
  • Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000 Apr;82(4):478-86.
  • Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg. 2002 Mar-Apr;11(2):143-50.

 

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer