Humerus shaft fracture (peds)

Background

• Uncommon
  • Consider abuse
  • If low energy mechanism, also consider pathologic fx
  • Direct trauma: transverse fracture
  • Violent rotation: spiral fracture
• Fracture fragment may injure radial nerve
  • Assess wrist extensors/supinators
  • Sensation of dorsoradial hand, thumb, and second digits

Differential Diagnosis

Humerus Fracture Types

Humeral anatomy

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

Diagnosis

• AP lateral humerus, include shoulder and elbow views

Treatment

Non-Operative

• Up to 30 degrees angulation is well tolerated
• Long arm posterior splint, sling and swathe splint, or coaptation splint
• ROM exercises in 2-3 weeks

Operative

• Open fractures
• Ipsilateral forearm injury "Floating elbow"
• Shoulder injury or poly trauma

Disposition

Non-emergent Ortho f/u

See Also

• Humerus fracture (peds)

References

• Harwood Nuss
• Orthobullets