Humerus shaft fracture

This page is for adult patients. For pediatric patients, see: humerus shaft fracture (peds)

Background

• Shaft defined as middle one-third of humerous from lesser tubercle to supracondylar ridges
• Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
• Common site of pathologic fractures (especially breast cancer)

Clinical Features

• Frequently occurs via direct blow, fall, or FOOSH
• Localized tenderness, swelling, pain

Differential Diagnosis

Humerus Fracture Types

Humeral anatomy

• Adult
  • Proximal
  • Shaft
  • Distal
    • Capitellum
    • Trochlea
    • Condylar
• Pediatric
  • Proximal
  • Shaft
  • Distal
    • Supracondylar
    • Lateral epicondyle
    • Medial epicondyle

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

• Shoulder Dislocation
  • Anterior shoulder dislocation
  • Posterior shoulder dislocation
  • Inferior shoulder dislocation
• Clavicle fracture
• Humerus fracture
• Scapula fracture
• Acromioclavicular joint injury
• Glenohumeral instability
• Rotator cuff tear
• Biceps tendon rupture
• Triceps tendon rupture
• Septic joint

Nontraumatic/Chronic:

• Rotator cuff tear
• Impingement syndrome
• Calcific tendinitis
• Adhesive capsulitis
• Biceps tendinitis
• Subacromial bursitis
• Cervical radiculopathy

Refered pain & non-orthopedic causes:

• Referred pain from
  • Neck
  • Diaphragm (e.g. gallbladder disease)
• Brachial plexus injury
  • Rucksack paralysis
• Axillary artery thrombosis
• Thoracic outlet syndrome
• Subclavian steal syndrome
• Pancoast tumor
• Myocardial infarction
• Pneumonia
• Pulmonary embolism

Evaluation

Workup

• AP and lateral views of humerus
• Consider additional views of elbow and shoulder

Diagnosis

• Rule-out radial nerve injury (wrist drop - no extension of wrist, fingers, or thumb)

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• U-shaped coaptation splint (upper arm sugar-tong splint) + sling and swathe

Disposition

• Outpatient ortho referral (if adequate pain control)

Subspecialty Orthopedic Care

Non Operative

• Most do not need surgery if
  • Less than 20% anterior angulation
  • 30% varus/valgus angulation
  • < 3cm shortening

Operative

• Neurovascular injury
• Significant soft tissue injury
• Open fracture
• Concern for compartment syndrome
• Floating elbow (ipsilateral forearm fracture)
• Neurovascular injury (radial nerve injury not contraindication to splinting)

See Also

• Humerus Fracture (Peds)
• Fracture (Main)