Return to normal function and motion may require 3 to 4 months overall goals. Humeral shaft fractures account for approximately 3% of all fractures. Management of humeral shaft fractures has historically been largely conservative. Intramedullary nail for long bone fractures femurtibia humerus kwires stainless steel pins which can be inserted percutaneously to hold bone fragments together. There is an increasing trend in the literature to perform operative fixation of these fractures. Humeral shaft fractures were identified by the international classification. Outcome in the conservative management of shaft of humerus fracture in functional brace rizwan lodhi1, syed baqir hussain jafree2 abstract background. Humeral shaft fractures pediatric orthopaedic society of. Humeral shaft fracture pediatric pediatrics orthobullets. Fractures of the humeral shaft are common injuries with multiple management strategies.
This, no doubt, proves that the ideal form of management still has to be found. The role of locking or hybrid locking plating techniques for humeral shaft fractures remains a topic of debate. This fracture is commonly seen in adult but in the rare case it may also happen to children. Shaft fractures are often managed surgically to reduce time. Middle third fractures damage this vessel higher rate of delayed union. Evaluation of the surgical treatment of humeral shaft fractures and. Request pdf management of humeral shaft fractures humeral shaft fractures account for approximately 3% of all 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. The long bone of the upper arm is known as the humerus. Compression plating versus intramedullary nailing of humeral shaft fractures. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Union rates are high, and they allow for immediate weight bearing on the upper extremity in the polytrauma setting. Humeral shaft fractures account for about % of all fractures. Orif was the original approach for the treatment of humeral shaft fractures. Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. Aaos modern day management of humeral shaft fractures july 10, 2019 director.
The humerus is the largest bone in the upper extremity figure 1 and figure 2. Radial nerve injury after operative management of humerus. With the increase in operative procedures for the management of humerus shaft fractures nonunion, iatrogenic acute radial nerve palsies can no longer be considered as rare events15,16. Imns are an attractive option for treatment of the humeral shaft fracture. A humeral fracture is a condition characterized by a break in the upper arm bone humerus figure 1. A proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. 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. 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.
Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. Fractures of the humeral shaft with primary radial nerve palsy mdpi. Voloshin, in shoulder and elbow trauma and its complications, 2015. These fractures are regarded as the domain of nonsurgical management. Rehabilitation programs for operative and nonoperative. A humerus fracture is a break in the large bone of your upper arm. 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. Humeral fracture are operated out of that 15 cases were fixed with plate and 15 cases were fixed with nail. Humeral shaft fractures are frequent, accounting for 1% to 3% of all fractures in adults. Extension and internal rotation not performed until 6 weeks 4.
In our series of 49 patients, the frequency of postoperative deficit was found in 8 patients 16%. The conventional surgical treatment options for humeral shaft fractures include imn and orif. It is a common injury, representing 3% to 5% of all fractures in adults. The full text of this article is available in pdf format. Rehabilitation programs for nonoperative humeral fractures dr. One of the most important features of humeral fractures in children is their ability to remodel and heal with minimal to no deformity despite displacement and angulation. Controlled compression nailing for at risk humeral shaft fractures.
In this article we will cover the middle part, that is the shaft of the humerus bone. Humeral shaft fracture, humeral anatomy, radial nerve palsy. Acute and chronic humeral shaft fractures in adults emconsulte. This represents a growing public health concern in a climate of cost containment. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Nonsurgical management of humeral shaft fractures with functional bracing gained. Pdf evaluating the outcome of management of humerus. In children, they are more common under age 3 and above age 12. Outcome in the conservative management of shaft of. In recent years, mipo has become another viable treatment option for surgical management of these humeral shaft fractures. Humeral shaft fractures have two common mechanisms. Surgical management of humeral shaft fractures what is.
Around 10% of long bone fractures are from upper limb. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Trauma is most common cause of fracture in young adults and in elderly, patients from standing fall can have fracture of humerus. Conservative treatment is inexpensive and has a low complication rate. It also represents 3% of all fractures in children and constitutes less than 10% of humeral fractures in children. Laing 1956 jbjs 38a main nutrient artery enters the humerus at the junction of the middle and distal third, or in the lower part of the middle third. Humeral shaft fractures musculoskeletal medicine for. Humeral shaft fractures journal of shoulder and elbow.
In the setting of normalquality bone and simple fracture patterns, standard compression plating remains an effective technique for humeral shaft fracture fixation. There are several types of humerus fractures, depending on the location of the break. Context functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Based on such needs, zuckerman and koval9 indicated surgical treatment in cases of exposed fracture, associated vascular injuries, floating. Part of the depuy synthes locking compression plate lcp 3.
Management of humeral shaft fractures jama surgery. The overall incidence of humeral fractures was 104. A great deal of controversy still persists as to the method of choice in treatment of shaft fractures of the humerus. Part of the depuy synthes locking compression plate lcp system implantquality 316l stainless steel or titanium alloy ti6ai7nb. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. Bony healing occurs usually within 6 to 8 weeks in adults 3. Many still regard nonoperative management as the standard of care. Midshaft humerus fracture treatment verywell health. Review article management of humeral shaft fractures. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Healing of a midshaft humerus fracture takes several months but often exercises to improve the mobility of the shoulder and elbow joints are initiated much sooner. Humerus shaft fracture an overview sciencedirect topics.
Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Fractures of the humeral shaft with primary radial nerve. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Evaluating the outcome of management of humerus shaft fracture by medial locking compression plate a prospective study. Bony healing occurs usually within 6 to 8 weeks in adults 2. See midshaft humeral fractures in adults and proximal humeral fractures in adults. The incidence of humeral shaft fractures has been increasing over time. Aaos modern day management of humeral shaft fractures. The treatment of most isolated humeral shaft fractures is commonly with a. The vast majority of humeral shaft and proximal humerus fractures can be treated nonsurgically, with focused physiotherapy and appropriate time for healing. Use of titanium elastic nails in the adult diaphyseal. The two complications often seen are injuries to the radial nerve and nonunion of the fracture. This chapter will focus primarily on proximal humerus fractures and humeral shaft fractures, specifically addressing clinical presentation, diagnosis, treatment options, and return to sport.
The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and. If a fracture or fracture repair is stable, then therapy should be started early. It is the third most common fracture that occurs in. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. The incidence is thought to be between 12 and 30 per 100,000 per year.