Humeral Shaft Fracture S42.399A 812.21

humeral shaft fracture xray

Shoulder cross section anatomy image

Humerus anatomy anterior image

anterior lateral approach humerus image

humeral shaft ORIF xray

humeral shaft external fixation X-ray

humeral shaft external fixation xray

Synonyms: humerus fracture, humeral shaft fx, humeral shaft fracture, broken arm

Humeral Shaft Fracture ICD-10 Codes

7th Character Modifiers

  • A – Initial encounter for closed fracture
  • B – Initial encounter for open fracture
  • D – Subsequent encounter with routine healing
  • G – Subsequent encounter with delayed healing
  • K – Subsequent encounter with nonunion
  • P – Subsequent encounter with malunion
  • S – Sequela

ICD-9 Codes

  • 812.21 – Shaft of humerus, closed
  • 812.31 – Shaft of humerus, open

Humeral Shaft Fracture Etiology / Epidemiology

  • Uncommon, ~3% of all fractures
  • Bimodal: young males (trauma), elderly females (falls)

Humeral Shaft Fracture Anatomy

  •  Musculocutaneous Nerve: pierces coracobrachialis 5–8 cm distal to coracoid.  Supplies biceps, coracobrachialis and brachialis.

  • Radial Nerve: wraps posterior midshaft; at risk in distal 1/3 fractures

  • See also Arm Anatomy

Humeral Shaft Fracture Clinical Evaluation

  • Pain, swelling, and deformity of the arm
  • Crepitus and abnormal motion at the fracture site
  • Document neurovascular status, especially radial nerve function (wrist extension, dorsal hand sensation)

Humeral Shaft Fracture Imaging

  • AP and lateral radiographs of humerus generally sufficient
  • Include shoulder and elbow if intraarticular involvement is suspected
  • CT/MRI rarely needed

Humeral Shaft Fracture Nonoperative Management

  • Indications: most closed, isolated fractures

  • Options:

    • Coaptation splint (initial)

    • Functional brace (Sarmiento) at 7–10 days

    • Hanging arm cast: not recommended for transverse fractures (distraction risk)

  • Acceptable Alignment Criteria:

  • ≤20° anterior angulation

  • ≤30° varus/valgus

  • ≤15° malrotation

  • ≤3 cm shortening

  • Functional Bracing:

  • Union rate: 96–100%

  • Healing time:

    • Closed: ~9.5 weeks

    • Open: ~14 weeks

  • Early pendulum, hand/wrist ROM

  • Adjust brace as swelling subsides

  • Contraindications: ipsilateral brachial plexus palsy

  • Custom thermoplastic braces improve outcomes vs commercial braces (Bodansky D, JSES 2024;33:1028)

Humeral Shaft Fracture Operative Management

Indications

Open fractures

Polytrauma

Floating shoulder/elbow

Segmental fractures

Bilateral fractures

Pathologic fractures

Nonunion

Progressive radial nerve palsy

Distal intraarticular extension

Obesity interfering with brace use

Vascular injury

 

  • Low-velocity gunshot wounds are not operative indications.

Humeral Shaft ORIF 24515

  • Plate/screw fixation

  • Screws should be placed in different planes (osteon orientation)

Humeral Shaft IM Nailing

  • Pros: minimally invasive

  • Cons: ↑ shoulder impingement, reoperation

  • ORIF vs IMN:

    • ORIF ↓90% risk of impingement

    • ORIF ↓75% risk of reoperation

    • No difference in nonunion, infection, or radial nerve palsy
      (Bhandari M, Acta Orthop. 2006;77:279)

Humeral Shaft External Fixation

  • Reserved for open fractures with soft tissue compromise or temporary stabilization

     

Radial Nerve Palsy

  • Seen in 11.1% of closed fractures

  • Most recover spontaneously (neuropraxia)

  • Initial management: brace, wrist cock-up splint, monitor

  • EMG at 6 weeks if no return

  • Exploration:

    • Not recommended for closed injuries

    • Consider at 3–4 months if no signs of recovery

    • Open fractures with nerve transection may warrant repair, though outcomes are poor

    • First muscle to return: brachioradialis
      (Ring D, J Hand Surg 2004;29A:144)
      (Holstein A, JBJS 1963;45A:1382)

Humeral Shaft Fracture Associated Injuries / Differential Diagnosis

  • Radial nerve palsy: most recover; consider EMG if no return at 6 wks
  • Radial nerve transection: poor results despite repair (Ring, J Hand Surg 2004)
  • Brachial artery injury
  • Proximal/distal humerus fx

Humeral Shaft Fracture Complications

  • Delayed union: >2–3 months
  • Nonunion: >4–6 months
  • Malunion: rare
  • Radial nerve palsy: 11% closed fx, 18% open; 60% entrapment rate

Humeral Shaft Fracture Follow-up Care

Time Management
Immediate Coaptation splint (non-op), posterior splint (op)
7–10 Days Switch to functional brace (non-op); begin passive ROM
6 Weeks Begin strengthening (if union progressing)
3 Months Full ROM expected; consider bone stimulator if delayed
6 Months Return to full activity/sport
1 Year Final radiographs, outcome assessment

Weight-bearing with crutches or walker is safe on a plated humerus
(Tingstad EM, J Trauma 2000;49:278)

Humeral Shaft Fracture Outcomes

  • Functional bracing: >95% union

  • Radial nerve palsy: 98% recover without surgery

  • ORIF and IMN both provide good long-term outcomes with different complication profiles

Humeral Shaft Fracture Outcome Measures

Humeral Shaft Fracture References

  • Bodansky D, JSES 2024;33:1028

  • Sarmiento A, JBJS 2000;82A:478

  • Koch PP, JSES 2002;11:143

  • Bhandari M, Acta Orthop. 2006;77(2):279

  • Carroll EA, JAAOS 2012;20:423

  • Rockwood & Green's Fractures in Adults, 6th ed

  • Ring D, J Hand Surg 2004;29A:144

  • Tingstad EM, J Trauma 2000;49:278

  • Holstein A, JBJS 1963;45A:1382