Occasionally it may be caused by falling onto an outstretched hand. Nov 16, 2018 traditionally, humeral shaft fractures have been described according to the following features. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new. Pdf plate fixation is the gold standard for diaphyseal fracture management, and the anterolateral approach is widely used by reconstructive. Outcomes following operative and nonoperative management of. The elbow joint is a hinge joint and consists of three components. While closed humeral midshaft fractures can be managed nonoperatively with reported union rates as high as 94% 9, the operative management of these fractures has become popular over the last two decades 10, 11. Stress fractures of the humeral shaft and proximal humeral fractures are. Medial approach to treat humeral midshaft fractures. So how does the humerus fracture from throwing a baseball. Review article management of humeral shaft fractures.
Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. Operative indications failure of closed management poor alignment, intolerance, lack of compliance, body habitus open fractures ipsilateral radius and ulna fractures polytrauma patients brachial plexus palsies pathologic fractures segmental fractures. It also includes the hinge of the elbow joint on the bottom. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Pdf medial approach to treat humeral midshaft fractures. Humeral fractures are the least common long bone fracture in small animals. The midshaft fracture appeared separate from the healing proximal humeral fracture, which remained intact. Proximal humeral fractures are relatively uncommon injuries. A broken arm is also called a midshaft humerus fracture the arm bone is called the humerus and the break occurs in the middle portion of the bone. Jul 15, 2012 mechanism of injury direct trauma is the most common especially mva indirect trauma such as fall on an outstretched hand fracture pattern depends on stress applied compressive proximal or distal humerus bending transverse fracture of the shaft torsional spiral fracture of the shaft torsion and bending oblique fracture usually associated. Complications may include injury to an artery or nerve, and compartment syndrome. A retrospective study article pdf available in journal of orthopaedic surgery and research 111 december 2016 with 695 reads. Humerus shaft fractures acta chirurgiae orthopaedicae et.
The most useful rehabilitation protocol is the threephase system. This fracture is commonly seen in adult but in the rare case it may also happen to children. Throwers fracture of the humerus mdedge emergency medicine. Open reduction and internal fixation of humeral shaft fractures. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Treatment is almost always immobilization due to the high remodeling potential of the pediatric humerus. This type of fracture occurs in people of all ages and can occur after a traumatic event, like a high speed motor vehicle accident, or after a simple slip and fall. Functional bracing of fractures of the shaft of the humerus. Multiple factors should be considered in management of. The humeral shaft is the middle portion of the bone with the shoulder joint at the top end and the elbow joint at the bottom. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately.
Humeral shaft fractures are those fractures of the diaphysis of the midshaft that do not involve the proximal or distal articular joints. Still, surgical management is indicated in certain situations, including. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. One of the nerves that travels from the neck to the hand, the radial nerve, spirals around the humeral shaft lying very close to the bone about. The low incidence of these fractures combined with the unique anatomy of the humerus makes repair of humeral fractures challenging. Humerus shaft fracture an overview sciencedirect topics. However, the medial approach is rarely discussed for humeral shaft fracture management. Bony healing occurs usually within 6 to 8 weeks in adults 3. As shown, this approach provides safe and effective access to the humeral shaft. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. The humerus is located in the upper arm and humerus fracture occurs due to a fall or direct trauma or may be caused by disease such as pagets disease. A brief guide to initial management of orthopedic injuries. To compare the outcomes of operative and nonoperative. The top of the arm bone is called the proximal humerus, and the bottom of the bone is called the distal humerus.
Imns are an attractive option for treatment of the humeral shaft fracture. Midshaft humerus fracture treatment verywell health. The treatment goal was the prompt return of the patient to. Midshaft humerus fractures are usually the result of. Proximal humerus fractures with greater than 50% displacement should be discussed with the orthopaedic team for further management. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Humeral shaft fractures musculoskeletal medicine for. A multicentre prospective comparative cohort study across 20.
Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. 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. Place these posters in your clinical areas as a visual reminder of the resources available. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Spirals around the humerus posteriorly, and reenters the anterior compartment laterally le to power the wrist and finger extensors the radial nerve is very susceptible to injury with any midshaft humerus fracture because it is fixed in the intermuscular septum, the nerve can become trapped when reduction is attempted. Extension and internal rotation not performed until 6 weeks 4. Evidence based management of midshaft clavicle fractures. Adult humerus shaft fractures midwest bone and joint. The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Plate fixation is the gold standard for the surgical management of humeral midshaft fractures, and the anterolateral approach is most commonly used 47.
In this article we will cover the middle part, that is the shaft of the humerus bone. Aaos modern day management of humeral shaft fractures. Iatrogenic, radial nerve, humerous, fracture, palsy, injury introduction fracture of the humerous are not uncommon1. While cancer metastasis was initially a concern, it was less likely given her duration of being cancer free, a specific mechanism of injury, and no evidence of cancerous growth present on the radiographs. The humerus is the bone in your upper arm, between your shoulder and elbow. If a fracture or fracture repair is stable, then therapy should be started early. No classification scheme for humeral shaft fractures. Humerus fractures are generally divided into three types of injuries based on the location of the fracture. Elderly patients with weaker bone can break their arm with relatively low levels of force e. Increase rom while protecting the fracture site you can be slightly more.
The management of proximal humerus fractures in adults is a challenging and demanding task. Fractures of the humeral shaft with primary radial nerve palsy mdpi. It also represents 3% of all fractures in children and constitutes less than 10% of humeral fractures in children. Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. Complications and injuries associated with midshaft femur fractures in the adult can be lifethreatening and may include hemorrhage, internal organ injury, wound infection, fat embolism, and adult respiratory distress syndrome. Age tends to be one of the driving factors for management of proximal humerus fracture because, according to brian s. There may be a decreased ability to move the arm and the person may present holding their elbow. A humerus fracture is a break of the humerus bone in the upper arm. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am.
Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention consider risk for compartment syndrome if any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present. Rehabilitation programs for nonoperative humeral fractures dr. A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be used for initial management of the fracture. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Reports of treating midshaft fractures with an open anterolateral. We present indications, anatomic considerations, and surgical techniques used to surgically treat a transverse, midshaft humerus fracture through an anterolateral approach. Mar 02, 2017 the humerus is located in the upper arm and humerus fracture occurs due to a fall or direct trauma or may be caused by disease such as pagets disease. Guthrie, k 2014 a funny fracture a case study describing the assessment and management of humeral shaft fractures, life in the fast lane. Nov 18, 2014 a wide range of joint preserving reconstructive techniques have been employed in the management of proximal humerus fractures. Splinting of the humerus fracture, including prolonged immobilization of the elbow, wrist, and mcp joints.
The humerus is the long, tubular bone that makes up the upper arm. Traditionally, humeral shaft fractures have been described according to the following features. Conservative management in a collar and cuff with the elbow at 90 degrees and orthopaedic fracture clinic follow up is sufficient for most proximal humerus fractures. This report describes the evaluation, diagnosis and conservative treatment of an 80yearold woman with a nonpathological ipsilateral fracture of the proximal, midshaft and distal humerus. Aug 18, 2019 a humerus fracture is an injury to the bone of the upper arm that connects the shoulder to the elbow.
Fractures of the humerus in young adults are typically the result of highenergy direct trauma. In children, they are more common under age 3 and above age 12. Radiographs distal humerus fracture radiographs elbow dislocation terrible triad elbow dislocation, radial headneck fracture, coronoid fracture volume 20 june 2019 initial management of orthopedic injuries in the emergency department. A midshaft humerus fracture is a type of broken arm. Pediatric humeral shaft fractures are usually traumatic in nature, although nonaccidental trauma and pathologic lesions can not be overlooked. Pdf ipsilateral fractures of the proximal, midshaft and. A humerus fracture refers to any break in this bone. Plate fixation is the gold standard for the surgical management of humeral midshaft fractures 1, 2, 3, and the anterolateral approach is most commonly used 4, 5, 6, 7. Study of functional outcome of surgical management of proximal humerus fracture by various modalities. It extends from your shoulder to your elbow, where it joins with the ulna and radius bones of your forearm.
Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Fractures abstract humeral shaft fractures account for approximately 3% of all fractures. These aim to reduce complications and optimize function by restoring anatomy and conferring stability for early rehabilitation and promotion of fracture union. A patients guide to adult humerus shaft fractures anatomy. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. The pdf of the article you requested follows this cover page. Nonoperative proximal humeral fracture rehabilitation protocol general principles. 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. Radial nerve injury after operative management of humerus. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. This surgical technique video demonstrates open reduction internal fixation of a simple, transverse, midshaft humerus fracture performed through an anterolateral approach. Humeral shaft fracture pediatric pediatrics orthobullets. Good outcomes depend on detailed fracture evaluation, careful patient selection with thorough consideration of individual patient characteristics, comorbidities and functional expectations and advanced surgical expertise across a wide range of.
Rehabilitation programs for operative and nonoperative. The long bone of the upper arm is known as the humerus. Dr balaji vinayaka mission kirubananda variyar medical college. Location proximal, middle, or distal type of fracture line transverse, oblique, spiral, comminuted, or segmental opened or closed status this article focuses on midshaft humerus fractures. A humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries i. Childhood fracture management education powerpoint presentation 30. Fracture may be caused by direct impact, motor vehicle accident, fall or tumours. Evidence based management of midshaft clavicle fractures kenneth g. This is because of the complicated anatomy of the medial aspect of the upper arm. Cohen, md, of the adena bone and joint center, chillicothe, ohio, functional. Bony healing occurs usually within 6 to 8 weeks in adults 2. A humeral fracture is a condition characterized by a break in the upper arm bone humerus figure 1.
While previous research has led to effective clinical and diagnostic evaluation and treatment of. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. To compare the outcomes of operative and nonoperative treatment of traumatic closed humeral midshaft fractures in adult patients. Plate fixation is the gold standard for the surgical management of humeral mid shaft fractures, and the anterolateral approach is most. The humeral shaft supplies the attachment for a number of powerful muscles. Pdf midshaft humeral fracture following a proximal humeral. However, good surgical outcomes can be achieved with proper patient selection. In addition, we demonstrate the use of a pushpull screw to aid in achieving appropriate compression across a fracture site. Splinting to immobilize the humerus fracture and elbow until open reduction and internal fixation orif of the fracture with exploration of the radial nerve can be performed. Project overview powerpoint presentation 5 mins for use in the emergency department to promote the new resource at staff meetings. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. The majority of both proximal and midshaft humerus fractures are nondisplaced and can be treated conservatively nonsurgically. Radiographs midshaft humerus fracture the orthopaedic journal at harvard medical school lightsey et al.
The art of femoral fracture care involves a balancing act between anatomic alignment and early functional rehabilitation of the limb. Return to normal function and motion may require 3 to 4 months overall goals. He is neurovascularly intact in his left arm and leg. Initial management should be which of the following. Tytherleighstrong 28 defined humeral shaft fractures as those occurring between the border of the insertion of the pectoralis major and the area above the supracondylar ridge. Its especially strong and is capped with the ball of the ballandsocket shoulder joint. The humerus joins with the shoulder blade to form the shoulder joint and the bones of the forearm radius and ulna to form the elbow figure 1.
This is the current gold standard method for conservative treatment of humeral shaft fractures. Humeral shaft fractures pediatric orthopaedic society of. Humeroulnar articulation humeroradial articulation and radioulnar articulation. Humerus fracture upper arm fracture johns hopkins medicine. Open reduction and internal fixation of humeral midshaft fractures. Although the nonoperative management of closed humeral midshaft fractures has been advocated for years, the increasing popularity of operative intervention has left the optimal treatment choice unclear. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22.
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