Humeral Shaft Fractures

Dr. Sayid omar Mohamed

 Anatomy of the Humeral Shaft
The shaft of humerus extends
proximally from 1-2 cm below the
surgical neck distally to 2 cm above
supracondylar region
Relevant Structures:
Radial nerve: runs against the
posterolateral surface of the bone
Deforming forces:
Deltoid & Pectoralis major
Direction depends on fracture site
Anatomy of the Humeral Shaft
 Mechanism of Injury (Etiology)

Direct injury: Motor vehicle accident

Indirect injury:
Falls on the outstretched hand or on the elbow
Throwing a ball
Arm wrestling
Pathologic causes
 Physical findings

Cardinal signs
Pain
Bruising
Swelling
Deformity
Tenderness
Look for associated NV injuries (radial nerve)
 Imaging

X-ray
Standard radiographic examination
AP
lateral view
CT/MRI if pathologic frx suspected or x-rays not
clear
AP & Lateral view left Humerus
 Management of Humeral shaft fractures
Nonsurgical
Most humeral shaft fractures
can be managed with conservative
treatment (nonsurgical)
Neither rigid immobilization
nor perfect alignment is
necessary for healing
Initial immobilization with hanging arm cast
with conversion to functional brace after 10 days
Duration of Immobilization is about 6-8weeks (adults)
Functional brace Hanging arm cast
 Management of Humeral shaft fractures
Surgical Indications
Failure of close reduction
Neurovascular damage
Multiple fracture of the same limb
Floating Elbow
Pathological frx
Open fractures
Non-union
Mal-union
 Management of Humeral shaft fractures

Surgical Options

Plate osteosynthesis
Intramedullary fixation
External fixation
 Complications
Nerve Injury: Radial nerve palsy (wrist-drop and
paralysis of the MCP extensors)
Commonly seen in oblique shaft fractures
Incidence varies 1.8% to 24%
Primary - occurs @ injury
Secondary: occurs later (closed or open management)
Vascular injury
Nonunion: incidence 0% to 15%