Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. This represents a growing public health concern in a climate of cost containment. All the fractures were in the distal humeral shaft, and butterfly fragments were accompanying in two soldiers. Main trauma mechanism for femoral shaft fractures is a direct. Fracture shaft humerus is the fracture of humerus between shaft. Humeral shaft fractures are defined as fractures in which the major fracture line occurs distal to the insertion of the pectoralis major and proximal to the supracondylar ridge. Humeral shaft fractures are the second most common birth fracture. Nov, 2017 the objectives of this trial are to compare the effectiveness and costeffectiveness between surgical treatment with plate osteosynthesis and conservative treatment with functional bracing for humeral shaft fractures.
This fracture occurred over the distal third of the shaft of the humerus. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. A proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. Treatment of humeral shaft fractures with antegrade. Complications of surgical treatment of humeral shaft fractures. May cause palsy seconary to tethering of radial nerve in. Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. These fractures have an annual incidence from to 14. The incidence of humeral shaft fractures has been increasing over time. Good or excellent outcomes are reported in 85% to 95% of patients. We treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately after injury. Femoral shaft fractures in children and adolescents scielo. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus 1.
Ao handbooknonoperative fracture treatment executive editor. In some individuals surgery may be offered in order to allow an earlier return to function. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. The fracture occurs between 43 and 47 years of age, with extremes of 15 and 97. University of groningen femoral shaft fractures in adults. Humeral shaft fractures musculoskeletal medicine for. Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. Management of these fractures has been discussed in surgical texts for more than. The primary aim of this study is to evaluate functional recovery after operative versus nonoperative treatment in adult patients who sustained a humeral shaft fracture. B wedge fracture c complex fracture nonoperative management continues as the mainstay for treatment of the majority of these injuries. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Traditionally, the treatment for closed femoral shaft fractures in children was a period of skeletal traction until signs of healing were seen on xray followed by spica.
Treatment of the humeral shaft fractures minimally. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Acute and chronic humeral shaft fractures in adults. You are advised to consult the publishers version publishers pdf if you wish to. Humeral shaft fracture summary radiology reference. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Ii proximal femoral fractures nonoperative treatment of 31b1 fractures. Humeral shaft fracture radiology reference article. Humeral shaft fractures pediatric orthopaedic society of.
Humeral shaft fractures account for 1 to 3% of all fractures in adults 1,2 and for 20% of all humeral fractures. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Compared with open reduction and internal fixation with a plate and screw construct, the treatment shown in figure a is associated with all of the following except. Humeral shaft fractures secondary to hand grenade throwing. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. However, good surgical outcomes can be achieved with proper patient selection. Mar 02, 2017 a proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. 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. There may be a decreased ability to move the arm and the person may present holding their elbow. I femoral shaft fractures management with minimal resources. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Controlled compression nailing for at risk humeral shaft fractures.
Fractures of the humeral shaft are associated with a profound temporary and in the elderly sometimes even permanent impairment of independence and quality of life. Men are affected in more than half the cases 5563%. This fracture is a hallmark of nonaccidental injury. Femoral shaft fractures are typically an emergency indication as delayed fracture stabilization is associated with an increased morbidity, and a longer hospitalization time 9. Humeral shaft fractures are the third most common type of long bone fracture. The management of humerus fractures with prefabricated braces. Age was the key criterion for treatment choice, with those under 3 years old group i being treated with immediate spica cast. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail t2, stryker for the humeral fractures. Pdf functional treatment of closed humeral shaft fractures. An intramedullary nail that can provide continual compression like a plate and mechan ical manipulation of the callous throughout the course of treatment is an. The full text of this article is available in pdf format. Compression plating versus intramedullary nailing of humeral shaft fracturesa metaanalysis.
Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Modern concepts of internal fixation of long bone shaft fractures advocate. A study of 329 consecutive cases with a statistical. A humeral shaft fracture complicated with anterior.
Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Dcp remains the best treatment for unstable fractures of the shaft of the humerus. Pdf nonoperative treatment of humeral shaft fractures. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. Both patient and fracture characteristics patient age, presence of associated injuries, softtissue status and fracture pattern need to be considered to select the appropriate treatment option.
Outcome of nonoperative vs operative treatment of humeral. Principles of nonoperative treatment surgical indications. Humeral shaft diaphysis can fracture following injury to the arm due to a direct fall or blow, automobile injury, gun shot wound, missile injury, and rarely, due to ballthrowing injuries. Treatment of the humeral shaft fractures minimally invasive. Although they occur in all age groups, a bimodal distribution is noted. Humeral shaft fractures repub, erasmus university repository. Immediate elbow and wrist range of motion rom is essential for successful therapy with.
Minimally invasive plating osteosynthesis for middistal. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Antegrade intramedullary nailing is an alternative for humeral shaft fracture treatment. The incidence is thought to be between 12 and 30 per 100,000 per year. Fracture of the humeral shaft associated to elbow dislocation and. 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. 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. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures.
Operative and nonoperative treatment of humeral shaft. Surgical results of open reduction and plating of humeral. Minimally invasive plate osteosynthesis versus open reduction and internal fixation article pdf available in trauma monthly 203 august 2015 with 103 reads. To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through. It is the third most common fracture that occurs in. Historically, the treatment of choice has been functional bracing. Listing a study does not mean it has been evaluated by the u. Fracture management for primary care, eiff p, hatch r, calmbach w eds, saunders, philadelphia 2003. For periarticular fractures of distal humerus see elbow. Microsoft powerpoint 800 cross humeral shaft fx author.
Humeral shaft fractures are generally simple fractures of the middiaphysis. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Femur fracture leads to reduced activity for 107 days, the average. Humeral shaft fracture management, a prospective study. In more elderly people, humerus fracture due to a fall is generally proximal, sub or infracapital. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Functional treatment of closed humeral shaft fractures. The treatment of choice is intramedullary fracture fixation. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Includes diaphyseal fractures of distal third of humerus. Open fracture foster et al, jhs, 1993 14 patients with open fractures 64% 9 with nerve injury interposed or lacerated. Outcome after closed functional treatment of humeral shaft fractures.
Minimal invasive ostheosintesis for treatment of diaphiseal ncbi. Management of femoral shaft fractures acta chirurgiae. The objectives of this trial are to compare the effectiveness and costeffectiveness between surgical treatment with plate osteosynthesis and conservative treatment with functional bracing for humeral shaft fractures. 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. Ekholm r, tidermark j, tornkvist h, adami j, ponzer s. B wedge fracture c complex fracture nonoperative management continues as.
The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to. The use of humeral fracture braces has become our preferred method of treatment for fractures of the shaft of the humerus. A humerus fracture is a break of the humerus bone in the upper arm. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. 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. 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. Intraoperative measurements included blood loss and operative time. Dec 21, 2004 we treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately after injury. There were significantly more consolidation problems in fractures in the proximal third 46% consolidated compared to those at the middle 81% consolidated and distal third 86%. Humeral shaft fractures account for 3% of overall 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.
Atypical injury of radial nerve after humeral shaft fracture. Secondary radial nerve palsy was reported in 3 cases, 1 of which had reexploration via the posterior approach. However, there are two age clusters for these fractures. The brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Your digital gateway to expertise, education, and innovation. The highest intraoperative complication rate occurred with the antegrade in sertion in 3 cases with added shaft fracture. Jun 16, 2012 fracture shaft of humerus include group of fracture where main fracture line lies distal to surgical neck of humerus and proximal to supracondylar ridge distally. Conservative treatment of closed fracture shaft humerus in. 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.
Humeral shaft fracture operative fixation arm docs. Surgical treatment is reserved for specific conditions. Humeral shaft fractures were identified by the international classification. In a recent analysis comparing different treatment options in femoral shaft fractures, it could be clearly stated. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. For more information, you can read a more indepth reference article. All the fractures healed without any clinical complications with conservative treatment. 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. The humeral shaft supplies the attachment for a number of powerful muscles. Fractures of the humeral shaft represent approximately 5% of all fractures.
Apr 08, 2009 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 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. It is the third most common fracture that occurs in individuals over the age of 65, after. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. It is estimated that these fractures comprise 35% of all fractures in adults. The incidence of primary lesion of the radial nerve in association with humeral shaft fracture is quoted at 11. These fractures can be treated operatively or nonoperatively, but the optimal tailored treatment is an unresolved problem. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury.
Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to the midshaft. Review article management of humeral shaft fractures. Because closed methods of treatment for humeral shaft fractures have a high rate of success, open reduction is rarely indicated. Fracture shaft of humerus include group of fracture where main fracture line lies distal to surgical neck of humerus and proximal to supracondylar ridge distally. 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. Femoral shaft fractures orthopaedic trauma association.
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