The humerus is the largest bone in the upper extremity. Comparative study between use of interlock nailing and. Review article management of humeral shaft fractures. The incidence of humeral shaft fractures has been increasing over time. Pdf operative treatment of humeral shaft fractures. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20%. Humeral shaft fractures pediatric orthopaedic society of. Application of contoured plates in buttress fashion no distal fixation 4. It can also happen due to sudden and opposite movement of the. Surgical interventions to treat humerus shaft fractures. Humeral shaft and distal humerus fractures are much less common than proximal humerus fractures. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. Supported by notable progress in surgery for trauma of the locomotor apparatus over recent decades, with better techniques and osteosynthesis.
Humeral shaft fracture summary radiology reference. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. Treatment of the humeral shaft fractures minimally invasive. This chapter focuses on the clinical presentation, diagnosis, treatment options, and longterm prognosis of humeral shaft fractures utilizing both retrospective and prospective data ranging from 1975 to 2017. Midshaft humerus fracture treatment verywell health. This type of fracture occurs close to the shoulder joint midshaft humerus fractures. Nonunion of the humeral shaft successfully treated with. Humeral shaft fracture is one of the common injuries encountered in orthopedic surgery 1 accounting for 1% 5% of all fractures 24. Humeral shaft fractures account for about % of all fractures. Pdf on jan 1, 2008, youngkyu kim and others published humeral shaft fracture. Clinical examination for fracture stability was routinely performed on patients by the treating physicians and documented it in the medical record. Extension and internal rotation not performed until 6 weeks 4.
There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Surgeons may use nails, plates, and screws to secure pieces of bone together. In general, closed humeral shaft fracture associated with radial nerve palsy presents a journal of orthopaedic surgery 25 3 spontaneous. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. Clavicle fractures generally heal rapidly without specific treatment and without sequelae. Fractures of the humeral shaft with primary radial nerve palsy mdpi. 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.
Although they occur in all age groups, a bimodal distribution is noted. Humeral shaft fractures were identified by the international classification. Treatment of middle third humeral shaft fractures with. Review article elastic stable intramedullary nailing of. P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial. Provisional internal fixation of articular surface to shaft 3. Complex fracture patterns pose greater challenges for treatment. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft.
Your digital gateway to expertise, education, and innovation. To determine outcome of functional bracing of fracture of humeral shaft in a tertiary care hospital of lahore. However, good surgical outcomes can be achieved with proper patient selection. Oct 01, 2003 a variety of treatment options for humeral shaft fractures have been studied and described including closed means, such as functional bracing, and open techniques with internal fixation. For periarticular fractures of distal humerus see elbow. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. A divergence of opinion exists in the literature between the values of imn and minimally invasive plating osteosynthesis for the treatment of middistal third humeral shaft fractures. Aaos modern day management of humeral shaft fractures. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Inci dence of humeral shaft nonunion ranges from 0% and 8% after conservative treatment of these fractures and. Humeral stress fractures seldom occur, but there are case reports, particularly among overhead athletes, weightlifters, gymnasts, and rowers.
Nonoperative treatment has been the perceived standard of care within the currently available literature for most patients with isolated injuries. Humeral shaft fractures have two common mechanisms. Of 240 humeral fractures, 60 per cent occurred in patients under 35 years old, 39 per cent of fractures being in the middle third of the shaft, 28 per cent were open with an infection rate of 4. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to preinjury level of function.
This fracture is a hallmark of nonaccidental injury. Most fractures of the humeral shaft can be treated nonoperatively with a coaptation splint, hanging arm cast, cuff and collar, or fracture brace. The majority of both proximal and midshaft humeral fractures are nondisplaced and can be treated conservatively ie, nonsurgically. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. Surgical treatment is reserved for specific conditions. This is the current gold standard method for conservative treatment of humeral shaft fractures. Ao handbooknonoperative fracture treatment executive editor. Nonoperative functional treatment has been considered the gold standard by numerous authors. This study evaluates different operative treatment options for patients with metastatic fractures of the humerus focusing on surgical procedures, complications, function, and survival rate. Aug 01, 2010 closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. This is an enhanced pdf from the journal of bone and joint surgery. Humerus and femur fractures occur infrequently and have an excellent prognosis for full healing. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures.
The overall incidence of humeral fractures was 104. Treatment of bilateral proximal humeral fracture in. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Indirect injuries are likely from a fall on the outstretched hand or from rotational injuries. Outcome in the conservative management of shaft of humerus. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview.
Multiple fractures in a newborn should suggest other musculoskeletal abnormalities such as osteogenesis imperfecta. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. The treatment of these fractures is mainly conservative and operative treatment is. Recent randomized clinical trials and metaanalyses even question the benefit of surgical treatment for displaced 3, and 4part fractures. Surgical treatment of three and fourpart proximal humeral. The most common site of fracture is at the junction of proximal rd and distal 23rd. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Outcome of nonoperative vs operative treatment of humeral. 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. A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be used for initial management of the fracture. This fracture generally is located in the shaft between the shoulder and elbow joint. Humerus fracture upper arm fracture johns hopkins medicine. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22.
In the case of fractures of the proximal humerus, early range of motion is the main aim of treatment. Introduction humerus fractures are relatively uncommon in childhood except for supracondylar humerus fractures. In fourpart fractures of the proximal humerus, the humeral head, both tuberosities, and the shaft are separated from one another, whereas in threepart fractures, one of the tuberosities remains attached to the humeral head. The most common treatment for a humeral shaft fracture is called a fracture brace, often referred to as a sarmiento brace, named after the physician who popularized this treatment method. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. Humeral shaft fractures are the second most common birth fracture. Indications for nonoperative and operative treatment humeral shaft 1. Good or excellent outcomes are reported in 85% to 95% of patients. Plating find, read and cite all the research you need on researchgate. The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and. This chapter focuses on the clinical presentation, diagnosis, treatment options, and longterm prognosis of humeral shaft fractures utilizing both retrospective and prospective data ranging from.
The incidence of proximal humerus fractures is 4% to 5% of 1all fractures. Surgical options for treatment of humeral shaft fractures include open. Minimally invasive plating osteosynthesis for middistal. 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. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Treatment of bilateral proximal humeral fracture in patients. Nonoperative proximal humeral fracture rehabilitation protocol general principles. It can also happen due to sudden and opposite movement of the arm against the violent contraction of the muscle. Functional bracing of fractures of the shaft of the 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. Introduction humeral shaft fractures represent 1%3% of all fractures and 20% of humeral fractures in adults. The increasing role of reverse total shoulder arthroplasty in the treatment of proximal humerus fractures.
Intramedullary fixation of humeral shaft fractures using an. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Proximal means it is the end of the bone that is closest to the body. Rehabilitation guidelines for proximal humerus fracture nonoperative 3 p a g e appointments continue physical therapy 12 xweek rehabilitation goals increase rtc strength restore scapulahumeral rhythm precautions none suggested therapeutic exercises posterior capsule stretching if indicated. Evaluation of the surgical treatment of humeral shaft fractures and. The incidence is thought to be between 12 and 30 per 100,000 per year. Most of the times these heal without requiring surgery, however, some severe cases may require surgical intervention. Treatment of humeral shaft fractures using antegrade nailing. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. They can be classified according to the fracture pattern, location, and tissues damaged. Humeral shaft fractures account for approximately 3% of all fractures.
It is estimated that these fractures comprise 35% of all fractures in adults. Complications after nonsurgical management of proximal. Parkinsons disease, proximal humeral fracture, conservative treatment 1. Humeral shaft fracture pediatric pediatrics orthobullets. The choice of operative treatment for a humeral shaft fracture. 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.
Inci dence of humeral shaft nonunion ranges from 0% and 8% after conservative treatment of these fractures and from 0% and % after surgical treatment. Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. Diaphyseal fractures humerus, femur and tibia orthopaedic trauma for pas and nps ota annual meeting, october 17, 2018 objectives 1. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Includes diaphyseal fractures of distal third of humerus. Humeral shaft fractures are challenging to manage as the treatment must be tailored to the individual patient and the specific fracture pattern. Most humeral shaft fractures unite if left alone in the same room. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately. Humeral shaft fractures constitute only 3% of fractures in children younger than age 16 years. Patients with pd have a high risk of fracture even under low energy because of postural impairments.
Sometimes this type of fracture is seen in a throwing injury that involves severe muscle contraction. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips. Fractures resulting from minor trauma may be caused by an occult unicameral bone cyst. In this study we have observed the outcome of humeral shaft fracture managed with conservative treatment using functional brace. Pdf treatment of the humeral shaft fractures minimally. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. There are three main surgical techniques to treat humeral shaft fractures. Humeral shaft fractures musculoskeletal medicine for. Treatment of the humeral shaft fractures minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace. Fracture site mobility at 6 weeks after humeral shaft. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used.
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. Treatment of humeral shaft fractures continues to be controversial. Treatment of the humeral shaft fractures minimally. Nonstress and stress fractures of the shaft of the humerus are discussed separately. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. Very frequently, they are associated with multiple injuries, leading to complications like shortening, malunion, infection. Humerus shaft fracture a humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries i. These fractures are regarded as the domain of nonsurgical management. The pdf of the article you requested follows this cover page. This usually results in a comminuted fracture or a simple transverse fracture. This represents a growing public health concern in a climate of cost containment.
Humeral shaft fractures journal of shoulder and elbow surgery. Pdf plate and screw fixation psf has always been the more common surgical treatment of humeral shaft fractures. Use of titanium elastic nails in the adult diaphyseal. The fracture can happen due to the direct injury or assault on the arm. This approach is based on publications such as that by sarmiento et al. Aaos modern day management of humeral shaft fractures july 10, 2019 director. Humeral shaft fracture radiology reference article. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Around 10% of long bone fractures are from upper limb. Modern surgery favors treatment modalities that are minimally invasive, have low morbidity, and provide rapid. Nonstress humeral fractures are discussed separately. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. They are most common in children younger than 3 and older than 12 years old.
With conservative treatment, union of humeral shaft fractures occurs in approximately 16 weeks 12. Surgical treatment for a proximal humerus fracture. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Functional treatment of closed humeral shaft fractures. F ractures of the humeral shaft account for approximately 3% of all fractures. Proximal humerus fracture book twin cities orthopedics. Surgical treatment of pathologic fractures of humerus. Physiologically induced motion at the fracture site favors healing of the fracture.
Nonoperative management of proximal humerus fractures. Esin, humerus, proximal, shaft, distal, fracture, children, operative, complications. A majority of proximal humeral fractures can be managed without surgery. 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. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. In contrast to proximal humeral fractures that do not involve the tuberosities, three and fourpart fractures are usually treated surgically. Goodtoexcellent results have been reported in most series of humeral shaft fractures introduction fractures of the humeral shaft are commonly encountered by the orthopedic surgeons. Pdf nonoperative treatment of humeral shaft fractures revisited. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. In some cases, the broken proximal humerus must be surgically repaired or replaced. See stress fractures of the humeral shaft and proximal humeral fractures in adults. If a fracture modifies the anatomy or function of the glenohumeral and scapulothoracic joints, the surgeon must adhere meticulously to treatment principles in order to ensure a satisfactory outcome.
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