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