The brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Discussion the treatment of nonunions differs from that of acute fractures. A series of five cases were presented in which similar fractures of the shaft of the humerus occurred during the hand grenade throwing activity during the military education. Outcome of management of humerus diaphysis nonunion.
Under imageintensifier control, make a lateral skin incision in the upper arm, about 5cm below the fracture and about 3cm long. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. A humeral shaft fracture complicated with anterior. Spiral fractures of the humerus in infants and toddlers are strongly linked with nonaccidental injury. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. F ractures of the humeral shaft account for approximately 3% of all fractures. Antegrade unreamed humeral nailing is an acceptable, safe and reliable treatment for humeral shaft fractures. For periarticular fractures of distal humerus see elbow. Management of these fractures has been discussed in surgical texts for more than. If you or a loved one has been injured in a traumatic accident, please call me at 916 9216400 or 800 4045400 for friendly and free advice. Humeral shaft nonunions with severe osteopenia presents challenges. Intramedullary nailing imn1,2 and minimally invasive plating osteosynthesis,3 which are both types of biological fixation, are safe and effective options for treating middistal third humeral shaft fractures. Humeral shaft fracture operative fixation arm docs.
Radiographs of her left arm demonstrate a spiral midshaft humeral fracture. Includes diaphyseal fractures of distal third of humerus. The main hypothesis is that operative treatment will result in faster recovery. The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, ao type 12a or 12b. These fractures have an annual incidence from to 14. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Operative and nonoperative treatment of humeral shaft. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Position the humeral shaft perpendicular to the horizontal plane in order to broach the canal. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. The two main methods of surgery for humeral shaft fractures are plate fixation. It typically doesnt involve the shoulder or elbow joints. This fracture is a hallmark of nonaccidental injury.
It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants 2 with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most frequently 3, while. Surgical versus nonsurgical interventions for treating humeral shaft fractures in adults. A mid shaft humerus fracture represents about 3% of all broken bones. Shaft or diaphyseal fracture of the humerus is defined as extra articular fractures of the humerus excluding 5 cm in each ends. Outcome of humeral shaft fractures treated by functional.
Humeral nonunion is defined as a fracture with no evidence of healing 24 weeks after injury. Pdf we treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately. For more information, you can read a more indepth reference article. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures.
In some individuals surgery may be offered in order to allow an earlier return to function. Surgical results of open reduction and plating of humeral. Humeral shaft fracture operative fixation the operation is performed to treat selected fractures of the humerus, which are displaced. Outcome of nonoperative vs operative treatment of humeral.
Fractures of the humerus can occur proximally, in the shaft diaphysis, or distally. Begin by using the smallest stem broach on the rasp. Plate fixation ws the only method used for the humeral shaft fractures. Les tableaux sont exclusivement disponibles en format pdf. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. Treatment options are generally inferred from the literature on the treatment of infection of long bones as the literature on specific treatment of humeral shaft infections is limited meyer et al. Outcome assessment of operative treatment of humeral shaft. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Most humeral shaft fractures unite if left alone in the same room.
Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. Minimally invasive plate osteosynthesis mipo of the humeral shaft. Pdf functional treatment of closed humeral shaft fractures. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6, 7, although this method can present unsatisfactory results, such as, nonunion and shoulder. Humeral shaft fractures secondary to hand grenade throwing. Fracture care for the community orthopedist william w. Ao handbooknonoperative fracture treatment executive editor. This represents a growing public health concern in a climate of cost containment. In more elderly people, humerus fracture due to a fall is generally proximal, sub or. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Good or excellent outcomes are reported in 85% to 95% of patients. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning.
Muller me, allgower m, willenegger h 1970 manual of inter. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. All the fractures healed without any clinical complications with conservative treatment. Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma. Operative and nonoperative treatment of humeral shaft fractures the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The incidence of humeral shaft fractures has been increasing over time. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. The incidence is thought to be between 12 and 30 per 100,000 per year. Nonoperative treatment with functional bracing has been regarded as the golden standard for treatment of closed humeral shaft fractures with studies reporting a high overall healing rate and an acceptable functional outcome.
A closed comminuted fracture of the distal shaft of the humerus in a 24yearold male patient sustained after falling off his motorcycle. The use of humeral fracture braces has become our preferred method of treatment for fractures of the shaft of the humerus. Humeral shaft fractures pediatric orthopaedic society of. Minimally invasive plating osteosynthesis for middistal. The assistant holds the humerus shaft in the neutral position, which is easy to control by angling the elbow. If a fracture or fracture repair is stable, then therapy should be started early.
Humeral shaft fracture summary radiology reference. Nonunion of humeral shaft fractures following flexible. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Humeral shaft fractures are generally simple fractures of the middiaphysis.
Fractures of the humeral shaft are at times associated. Pdf nonoperative treatment of humeral shaft fractures. Treatment of the humeral shaft fractures minimally. A divergence of opinion exists in the literature between.
Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures. Humeral shaftfractures conservative treatment 90% of humeral shaft fractures heal with nonsurgical management 20degrees of anterior angulation, 30 degrees of varus angulation and up to 3 cm of shortening are acceptable most treatment begins with application of a coaptation spint or a hanging arm cast followed by placement of a fracture brace. Humeral shaft fractures were identified by the international classification. The incidence of primary lesion of the radial nerve in association with humeral shaft fracture is quoted at 11. The most common cause of a humeral shaft fracture is a fall, but highenergy injuries motor vehicle collisions, sports injuries. Complex fracture patterns pose greater challenges for treatment. Humeral shaft fractures account for 3% of overall fractures. Such devices provide multiple fixed angle anchorage points and improve fracture fixation stability in weak bone.
The surgical treatment, made with open reduction and tough internal fixation plate. The majority of both proximal and midshaft humeral fractures are nondisplaced and can be treated conservatively ie, nonsurgically. Review article management of humeral shaft fractures. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus 1. Are the classical complications of open fracture surgery screw fixation, wiring, plate fixation. It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most frequently, while type c is. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Humeral shaft fracture orthopedics medbullets step 23. Outcome of nonoperative vs operative treatment of humeral shaft fractures.
Osteosynthesis of the humeral shaft fractures, with bridge plate. B good alignment after plate and additional lag screw fixation. A midshaft humerus fracture represents about 3% of all broken bones. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children.
Bring the fractured proximal humeral shaft into the wound by removing the bolster and extending the arm in slight adduction. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. Humeral shaft split fracture around proximal humeral. However, good surgical outcomes can be achieved with proper patient selection. She is given appropriate analgesia and placed in a coaptation splint. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Listing a study does not mean it has been evaluated by the u.
We report two cases of early proximal humeral fracture fixation failure in osteoporotic bone by humeral shaft fissure or split fracture after open reduction and internal fixation. Conservative treatment for humeral shaft fractures can lead to serious. Surgical interventions to treat humerus shaft fractures. All the fractures were in the distal humeral shaft, and butterfly fragments were accompanying in two soldiers. Locking plates increasingly are being used in the treatment of osteoporotic fractures. Midshaft humerus fracture treatment verywell health. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus.
Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Case report treatment of 10 year humeral shaft nonunion with. Local debridement of nonviable tissue and sequestrum. Systematic plate fixation of humeral shaft fractures. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age. Various techniques and devices have been used in the treatment of nonunion of the humeral diaphysis including open reduction and internal fixation with a dynamic compression plate and autogenous bone graft 12, 14, 15. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Surgical interventions for treating humeral shaft fractures in adults. One patient who had an open humeral shaft fracture and ipsilateral open monteggia fracture dislocation which required repeat surgery for recurrent dislocation of the radial head. Humeral shaft fractures account for % of all fractures and approximately 20% of all humeral fractures.
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