The classification by muller et al and the group that they founded known as the ao group is more complete, with division of hsfs as shown in figure 1. Minimally invasive plating osteosynthesis for middistal. Is there a place for external fixation in humeral shaft. Nondisplaced or minimally displaced fractures can be treated conservatively whereas surgical fixation is usually indicated in the cases of displaced fractures. Humeral shaft fractures repub, erasmus university repository. Most of these fractures occur red in the middle third of humeral diaphysis and was treated conservatively. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. Radial nerve injuries are the most frequent nerve lesion associated with fractures of the shaft, with a reported incidence of radial nerve damage in almost 11.
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. Over two and a half years, 56 patients with an acute. Fracture management for the small animal practitioner pdf. Study protocol open access treatment of the humeral.
Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. The incidence of primary lesi on of the radial nerve in association with humeral shaft fracture is quoted at 11. Volume 7 issue 2 international journal of contemporary. There was no radial nerve palsy in any of the cases and all achieved fracture union. The cause of a humerus fracture is usually physical trauma such as a fall. The drill holes may be placed 2 cm distal to the fracture line if bone is very soft. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. Twopart fractures of the articular surface and 4part fractures have a high incidence of avascular necrosis of the humeral head. F ractures of the humeral shaft account for approximately 3% of all fractures. Mechanism of injury and management in traumatic anterior. Aaos modern day management of humeral shaft fractures.
An overview of fracture types identified by the three observers according to the neer, aoota 2007, and new aoota 2018 classifications for proximal humeral fractures is included in additional file 1. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Sep 19, 2014 the humerus is a relatively common site of pathological fracture. Patients with neurovascular injuries requiring immediate surgery excl. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Complications may include axillary nerve or axillary artery injury. Review of literature of radial nerve injuries associated with humeral fracturesan integrated management strategy. Fractures involving the distal humerus continue to challenge orthopedic surgery.
Humeral shaft fracture summary radiology reference. Treatment of distal humeral fractures using conventional. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. Humeral shaft fractures are a relatively common injury with an incidence of 14. Patients with a pathological, recurrent or open humeral shaft fracture. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1,2 and for 20% of all humeral fractures 3. The first is the wright and cofield classification system, which is based on the location of the fracture in relation to the tip of the humeral stem. Additional traumatic injuries of the affected arm that influence upper extremity function. Results of surgical treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone grafting ajaz ahmad bhat, suhail wani, javed ahmad nabir. Dacron suture through them, are made in the shaft at about 1 cm below the fracture line, and centered about the bicipital groove on the shaft image 14.
Acceptable cpt codes for the abos sports subspecialty case list. Patients with a humeral fracture treated with an external fixator. Overlay the humeral head template on the radiograph of the fracture and compare it to the humeral head size from the opposite side. Intramedullary nail versus dynamic compression plate. Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. In order to bring systems of treatment up to date and to better our results at beekmandowntown. Fractures of the proximal humerus including 2part surgical neck fractures, 3part fractures and 4part fractures. Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures. This is a temporary file and hence do not link it from a website, instead link the url of this page if you wish to link the pdf file. Various surgical options have been used for treatment of 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. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. Good or excellent outcomes are reported in 85% to 95% of patients. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6,7, although this method can present.
Fractures of the shaft of humerus are commonly encountered by orthopaedic surgeons, representing 12% of all fractures. Traumatic anterior dislocation of the shoulder with concomitant humeral shaft and ipsilateral scapula fracture is a serious but rare injury. Abstractthere is a debate regarding the choice of operative intervention in humeral shaft fractures that require. Humerus shaft fractures acta chirurgiae orthopaedicae et. 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. Plate osteosynthesis of humeral shaft fractures is an established surgical procedure. Modern concepts of internal fixation of long bone shaft fractures advocate. 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. The objective of this study was to evaluate functional outcome of locking plate used for fixation of these fractures after open reduction. There have been reports of anterior dislocation with humeral fracture in the literature, but its association with. The posteroanterior locking for the distal humerus nailing. On the other hand, establishing stability by internal fixation may be technically demanding in the face of complex. Humeral shaft fractures pediatric orthopaedic society of. Various articles have reported successful outcomes using the phlp when compared with other implant designs.
Media in category fractures of shaft of the human humerus the following 3 files are in this category, out of 3 total. A nonunion or a posttraumatic paralysis of the radial nerve may be indications for external fixation as well as fractures associated with multiple injuries. Handbook of fractures 5th edition pdf free download. These fractures have an annual incidence from to 14. An evidencebased approach 2nd edition pdf for free download. This can be prevented by the early initiation of a rehabilitation program. Spiral fractures of the humerus in infants and toddlers are strongly linked with nonaccidental injury. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Humerus shaft fracture an overview sciencedirect topics. Review article management of humeral shaft fractures.
Prognostic factors for radial nerve palsy associated with humeral shaft fracture. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Simple humeral shaft fractures aoota classification types a and b were reduced by open reduction or closed reduction and fixed with a narrow 4. However, many complications still occur with use of the phlp, such as avascular necrosis of. The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. The incidence of fractures of the middle part shaft of the humerus increases with age. A fracture of the shaft of the humerus constitutes 3% to 5% of all fractures 1, 2. Humeral shaft fractures musculoskeletal medicine for. Limb swelling predating fracture, or marked post fracture swelling. Introduction a fracture of the shaft of the humerus constitutes 3% to 5% of all fractures 1,2. Treatment of the humeral shaft fractures minimally.
Studies published in the past decade that included more than 50 patients demonstrate a 10%23% rate of humeral shaft nonunion after functional bracing. 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. Fractures of humeral shaft are commonly encountered by. Distal humeral fractures comprise approximately 2% of all fractures and onethird of all humeral fractures. Apr 26, 2017 diaphyseal humerus fracture free pdf ebooks. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Fracture care for the community orthopedist william w.
Proximal humeral fractures are common injuries with increasing incidence, particularly in the aging population. Use of titanium elastic nails in the adult diaphyseal humerus. 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. A proximal humerus fracture is a break of the upper part of the bone of the arm humerus. A great deal of controversy still persists as to the method of choice in treatment of shaft fractures of the humerus. Select the size of the humeral head template that most closely matches the diameter of the patients humeral head. Suspect pathological fracture if any of the following features are present. The recommendation at that time was open exploration of the radial nerve as the large lateral bone spike had an association of nerve laceration and entrapment figure 7. Nonunion occurred in two patients in group 1 and in no patients in group 2.
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. Two classification systems are commonly used for shoulder arthroplasty periprosthetic fractures of the humeral shaft. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. There may be a decreased ability to move the arm and the person may present holding their elbow. Ilizarov treatment of humeral shaft nonunion in an. Intraoperative measurements included blood loss and operative time.
The aim of this study is to evaluate the outcome of humeral shaft fractures treated with external fixation which. Management of these fractures has been discussed in. The humerus nailing locking options in the conventional nailing systems are placed in the anteriorposterior and lateralmedial directions. Treatment of middle third humeral shaft fractures with. Management of humeral shaft fractures jama surgery. Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma rochester, mn 2014 mfmer slide2 disclosures i have no disclosures. The innovative screwinscrew technology offers customizable stability for the individual patient. Conservative treatment, plate fixation, or prosthesis for. Fluoroscopic technique for open reduction and internal.
Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. If the shoulder is extended or flexed, an anterior or posterior dislocation is produced correspondingly. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Wallny et al14 retrospectively compared 44 patients with humeral shaft fractures treated with functional bracing group 1 with 45 patients treated with a locking intramedullary im nail group 2. Iatrogenic radial nerve palsy appears to be common complication in treating these fractures. Open reduction and internal fixation orif with plate and screw has traditionally been the preferred method to surgically treat humeral shaft fractures. Handbook of fractures 5th edition pdf free download direct link. The free ends of the suture are brought out external to the shaft. The epidemiology of fractures of the humeral shaft has. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Formosan journal of surgery prognostic factors for radial. Tytherleighstrong 28 defined humeral shaft fractures as those occurring between the border of the insertion of the pectoralis major and the. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers.
The humeral shaft fracture fixation hufix study is a singlecentre prospective randomised controlled trial that aims to assess whether there is any difference in outcome between patients with a humeral shaft fracture who are managed operatively i. Spiral fractures of the distal humeral shaft at the level where the radial nerve. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Radial nerve injuries are the most frequent nerve lesion associated with fractures of the shaft 3, with a reported incidence of radial nerve damage in almost 11. There is a good indication for unilateral axial dynamic external fixation in fractures of the humeral shaft when the fracture appears in the distal third or in cases of bilateral fractures. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. The most common complication of proximal humerus fracture is adhesive capsulitis. The treatment of displaced proximal humerus fractures, especially in elderly, remains controversial. Anteromedial plating of humerusan easier and effective. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis, 1963. Jul 15, 2012 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.
Humeral shaft fractures account for approximately 1. Includes diaphyseal fractures of distal third of humerus. Reliability and reproducibility of the new aoota 2018. The distal interlocking is regarded as an inherent part of the antegrade humeral nailing technique. Importance humeral shaft fractures traditionally have been treated nonsurgically, but there has been a steady increase in the rate of surgery over the past 2 decades without highquality evidence to justify the trend objective to compare the effectiveness of surgical treatment with open reduction and internal plate fixation to nonsurgical treatment with functional bracing in the treatment of.
When trying to decide between two sizes, the smaller size should be selected. A case series of 20 fracture shafts of humerus were treated with anteromedial plating through anterolateral approach. The overall incidence of humeral fractures was 104. Compression plating versus intramedullary nailing of humeral shaft fracturesa metaanalysis. Radiographs showed an anterior dislocation of the shoulder with a transverse fracture of the middle third of the humeral shaft on the same side. The incidence is thought to be between 12 and 30 per 100,000 per year.
Instructions for use are found in the information that accompanied the product packaging. Effect of surgery vs functional bracing on functional. This fracture is a hallmark of nonaccidental injury. Humeral shaft fractures account for up to 5% of all fractures. To ensure usersafety and faster downloads, we have uploaded this. Most humeral shaft fractures unite if left alone in the same room. For periarticular fractures of distal humerus see elbow. Fractures of the humeral shaft are associated with a profound temporary and in the elderly sometimes even permanent. Fractures of the humeral shaft are relatively frequent accounting for 20% of humeral fractures and approximately 35% of all fractures. Surgical technique for open reductioninternal fixation of. Humeral shaft fractures humeral shaft fractures spiguel, andre.
The cause is generally a fall onto the arm or direct trauma to the arm. The most frequently used universal modifier was 5a, which corresponds to anterior dislocation and was found in 7 out of 116 fractures 6%. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. A humerus fracture is a break of the humerus bone in the upper arm. This represents a growing public health concern in a climate of cost containment. A proximal humerus fracture is a break of the upper part of the bone of the arm. Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail. Many surgical techniques have been introduced to correct humeral shaft fractures, and there have been debates regarding their clinical indications. External modular fixation for humeral shaft fracture. Formosan journal of surgery prognostic factors for. Medial approach to treat humeral midshaft fractures.
In the neutral position a fracture of the humeral neck or of the glenoid usually occurs. The proximal humeral locking plate phlp is a recently developed fixedangle implant that is an option for open reductioninternal fixation of an unstable displaced proximal humeral fracture. Outcome after treatment of humeral shaft fractures. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Acute and chronic humeral shaft fractures in adults sciencedirect. Humeral shaft fractures, plate osteosynthesis, anterolateral approach. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Download pdf proximal humerus fracture plate, nail or replace. The humeral shaft supplies the attachment for a number of powerful muscles. Approximately 115% of these fractures progress to nonunion 27. Electromagnetic distal targeting system does not reduce. Surgical treatment is reserved for specific conditions. Femoral and humeral heads, designed to provide immediate structural support to restore.
Review of literature of radial nerve injuries associated. A humeral shaft fracture complicated with anterior. Other causes include conditions such as cancer in the bone. Most humeral shaft fractures can be treated using the functional bracing method. Cortical struts, designed to reinforce cortical defects and provide immediate structural support. Although they occur in all age groups, a bimodal distribution is noted. Mary schuler murphy, lauren davis, in hand and upper extremity rehabilitation fourth edition, 2016. Humeral shaft fracture radiology reference article. Should this trend continue, the fracture rate would triple over the next three decades.
In this article, we are sharing with our audience the genuine pdf download of handbook of fractures 5th edition pdf using direct links which can be found at the end of this blog post. This study was designed to measure early postoperative outcomes of plate vs. Pdf external modular fixation for humeral shaft fracture. Ulnar nerve injury after a comminuted fracture of the. Physiologically induced motion at the fracture site favors healing of the fracture. 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. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. Multiloc humeral nails provide a comprehensive system for the treatment of humeral fractures. Humeral shaft fractures are those fractures of the diaphysis of the midshaft that do not involve the proximal or distal articular joints. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. The multiloc proximal humeral nail short is indicated for. However, good surgical outcomes can be achieved with proper patient selection. It is estimated that these fractures comprise 35% of all fractures in adults.
The results of this treatment were excellent, in comparison to what little data are available describing treatment of open humeral shaft fractures with either intermedullary nails or with external fixation. Injury to the ulnar nerve after humerus shaft fractures is a very rare entity as the ulnar nerve is well protected from the bone. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. The risk of functional impairment following nonoperative treatment is high 46.
We herein report a distal humeral diaphyseal fracture in a child. Humeral shaft fractures account for 3% of overall fractures. Controlled compression nailing for at risk humeral shaft. This, no doubt, proves that the ideal form of management still has to be found. We also attempted to evaluate the complications and predictors of loss of fixation for such an implant.
May 08, 2012 humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. A 6yearold boy fell from a chair, injuring his left elbow. It is believed that the dislocation occurs first and the action of secondary forces results in the shaft fracture. A prospective randomised controlled trial of operative. Traditionally the distal locking of intramedullary humeral nails is achieved using a freehand technique. Nonunion of the humeral shaft in patients with antiepileptic drug associated metabolic bone disorder constitute a challenging surgical problem difficult to treat due to seizure activity, osteoporosis, and poor stabilization options. 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. The incidence of humeral shaft fractures has been increasing over time. Pdf humeral shaft fractures account for about % of all fractures. Delayed radial nerve palsy after closed reduction of a pediatric humeral shaft fracture.