Humerus shaft fracture

Background

• Peaks in third and seventh decades of life (young men and osteoporotic elderly women)
• Occurs via direct blow or FOOSH
• Common site of pathologic fractures (esp breast cancer)
• Rule-out radial nerve injury (wrist drop - no ext of wrist, fingers, or thumb)

Clinical Features

• 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

Diagnosis

• Obtain views of humerus, elbow and shoulder

Management

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

Disposition

• May treat as outpatient, if adequate pain control

See Also

• Humerus Fracture (Peds)
• Fracture (Main)