Still, surgical management is indicated in certain situations, including polytraumatic injuries, open fractures, vascular injury, ipsilateral articular fractures. The recommendation at that time was open exploration of the radial nerve as the large lateral bone spike had an association of nerve laceration and entrapment figure 7. Functional treatment of the distal third humeral shaft. Humeral shaft fracture treatment in the elite throwing. The isolated medial humeral epicondyle fracture treated nonoperatively. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. Simple and complex fractures of the humerus a guide to. This fracture pattern is known as the holsteinlewis humeral shaft fracture after the authors who first described the pattern in 1963 holstein and lewis, 1963. Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. Intramedullary nailing of humeral head and humeral shaft fractures figures 1a to 1c. Includes diaphyseal fractures of distal third of humerus. Centre hospitalier du mans, 194, avenue rubillard, 72037 le mans cedex 9, france a r t i c l e i n f o article history.
Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. This represents a growing public health concern in a climate of cost containment. Dogs and cats that presented with traumatic humeral fractures were enrolled in the study. Humerus shaft fracture associated with traumatic radial nerve. Humeral shaft fractures represent approximately 3% of all longbone fractures and have historically been treated successfully in a nonoperative way, but surgical management is indicated in several conditions. Outcome of nonoperative vs operative treatment of humeral.
We use narrow shaft diameter and deepfluted new generation reamers also, so as to provide more relief space for medullary contents. Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. A humeral shaft fracture complicated with anterior. These fractures have an annual incidence from to 14. We treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately after injury. 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. This report provides evidence that mipo is a compelling alternative to open reduction and internal fixation in the treatment of various humeral fractures. Fortunately, most fractures of the humeral shaft respond to treatment without surgery.
A patients guide to upper arm fractures fractures of the shaft of the humerus with animated surgical video. See stress fractures of the humeral shaft and proximal humeral fractures in adults. Treatment of the humeral shaft fractures minimally. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. Our survey highlight the tendency for a more aggressive management of any humeral shaft fracture associated with a traumatic radial nerve palsy, with surgeons preferring to use orif with acute exploration of the radial nerve. It may also result following lowenergy injury or fall in patients with significant osteoporosis or. Intramedullary nailing imn1,2 and minimally invasive plating osteosynthesis,3 which are both types of biological fixation, are safe and effective options for treating middistal third humeral shaft fractures.
If you or a loved one has been injured in a traumatic accident, please call me at 916 9216400 or 800 4045400 for friendly and free advice. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. There are cases of twopart fracture dislocation associated with humeral shaft fracture 2, 58, 10. In surgical treatment for hsfs, the surgical technique and the quantity and quality of the synthesis. Pdf download for operative versus nonoperative treatment of. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. The treatment of these fractures is mainly conservative and operative treatment is usually reserved for specific circumstances. Humeral shaft fractures constitute around 1% of adult fractures in the uk, with an annual incidence of approximately per 00 population. Based on these findings, we suggest that plating of humeral shaft fractures should be considered as the primary treatment for all. Dec 21, 2004 we treated 93 consecutive patients, average age 53 1690 years, with closed humeral shaft fractures applying a functional brace immediately after injury. To date, no randomised controlled trial rct has compared operative treatment of humeral shaft fractures with conservative treatment. 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.
The humerus is the largest bone in the upper extremity. The purpose of this study is to compare the outcomes of intramedullary nailing and plate fixation in the treatment of humeral shaft fractures using metaanalysis. Humeral shaft fractures pediatric orthopaedic society of. To present the correlation between the clinical and radiographic results of patients with a humeral shaft fracture treated with the mipo technique. Humeral shaft fracture radiology reference article. Humeral shaft diaphysis can fracture following injury to the arm due to a direct fall or blow, automobile injury, gun shot wound, missile injury, and rarely, due to ballthrowing injuries. Voloshin, in shoulder and elbow trauma and its complications, 2015.
Treatment of the humeral shaft fracturesminimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1,2 and for 20% of all humeral fractures. Ao handbooknonoperative fracture treatment executive editor. The incidence is thought to be between 12 and 30 per 100,000 per year. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6,7, although this method can present unsatisfactory results, such as. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures. Compound fracture of humeral shaft associated with two. Pdf nonoperative treatment of humeral shaft fractures.
Humeral shaft fractures account for up to 5% of all fractures. Introduction humeral shaft fractures represent 1%3% of all fractures and 20% of humeral fractures in adults. This fracture is a hallmark of nonaccidental injury. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Conclusions conservative treatment of humeral shaft fractures has a higher rate of nonunion, while operative treatment is associated with a low incidence of.
The incidence of radial nerve palsy rnp after a humeral shaft fracture has been estimated to be between 7 and 17%, making it the most common nerve lesion complicating long bone fractures 33. The shoulder serves as a connection between the chest and arm. They are seen in 218% of patients with fractures of the middle third of the humerus figure 47. Transverse 80% 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. The aim of the current study was to comparethe outcome after operative 28 and nonoperative treatment of humeral shaft fractures, by comparing the time to radiological. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. Backgroundhumeral shaft fractures are common but debate still occurs as to. A divergence of opinion exists in the literature between. The treatment of such cases must be different from the initial treatment. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. There were significantly more consolidation problems in fractures in the proximal third 46% consolidated compared to those at the middle 81% consolidated and distal third 86%. Imns are an attractive option for treatment of the humeral shaft fracture. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. Humeral shaft fractures musculoskeletal medicine for.
Dcp remains the best treatment for unstable fractures of the shaft of the humerus. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately. There were significantly more consolidation problems in fractures in the proximal third 46% consolidated compared to those at the middle 81%. Eleven dogs and 4 cats with traumatic nonarticular humeral fractures. Treatment of the humeral shaft fractures minimally invasive. Intramedullary nailing of humeral head and humeral shaft. A humeral shaft fracture complicated with anterior shoulder. Management of humeral shaft fractures abstract humeral shaft fractures account for approximately 3% of all fractures. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus, and the middle third of the. Good or excellent outcomes are reported in 85% to 95% of patients. Direct contusion of the nerve and injury by fracture fragments is not uncommon.
Acute and chronic humeral shaft fractures in adults sciencedirect. Longterm results of treatment of fractures of the medial humeral epicondyle in children. Humeral shaft fracture is a common entity encountered in orthopedic surgery, it represents about % of all fractures, 510% of all long bone fractures and 20% of all humeral fractures 1,2. Outcome of humeral shaft fractures lo scalpello journal. Humeral shaft fractures account for 35% of all fractures 1,3. Union rates are high, and they allow for immediate weight bearing on the upper extremity in the. Anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. If a fracture modifies the anatomy or function of the glenohumeral and scapulothoracic joints, the surgeon must adhere meticulously to treatment.
Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. 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. Humeral shaft fracture humeral anatomy radial nerve palsy a b s t r a c t humeral shaft fractures account for up to 5% of all fractures. Open reduction and internal fixation of humeral shaft. 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 study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care.
Humerus shaft fracture associated with traumatic radial. Although there are numerous randomized clinical trials and metaanalyses that have attempted to guide surgeons, there is little evidence and no consensus as. A three dimensional ct scan shows the detail of a comminuted humerus shaft fracture. A combination of fracture shaft of humerus with ipsilateral shoulder fracture dislocation is rare injury. Surgical treatment is reserved for specific conditions. Although conservative treatment of these fractures results in satisfactory clinical and functional outcomes, it may result in varus deformity and. Minimally invasive plate osteosynthesis mipo for treatment. Most humeral shaft fractures unite if left alone in the same room. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. The incidence of humeral shaft fractures has been increasing over time. May cause palsy seconary to tethering of radial nerve in lateral intermuscular septum or entrapment in fracture site.
Review article management of humeral shaft fractures. Minimally invasive plating osteosynthesis for middistal. Although they occur in all age groups, a bimodal distribution is noted. Although conservative treatment of these fractures results in satisfactory clinical and functional outcomes, it may result in varus deformity and limitation of shoulder and elbow. Nov 23, 2009 anterior dislocation of the shoulder joint with an ipsilateral fracture of the humeral shaft is a rare injury which may require demanding technical skills. Your digital gateway to expertise, education, and innovation. The treatment of humeral fractures is a complex issue and the source of considerable controversy. The ideal candidate for this treatment is a patient with an isolated fracture. Spiral fractures of the humerus in infants and toddlers are strongly linked with nonaccidental injury. Operative versus nonoperative treatment of humeral shaft fractures. Nov 16, 2018 the reported technique was associated with good outcomes in a large variety of fracture configurations and animal sizes, with no complications. Humeral shaft fractures have a significant risk of causing radial nerve entrapment or injury at the spiral groove.
Humeral shaft fractures were identified by the international classification. Although fractures the clavicle collarbone and proximal portion of the humerus are more common, humeral shaft fractures occur in frequency and may be associated with pain and deformity. The first peak is seen in the third decade in males and the second peak in the seventh decade in females 3. Pdf operative treatment of humeral shaft fractures.
Humeral shaft fractures account for % of all fractures and 20 % of the fractures 27 involving the humerus. A prospective randomised controlled trial of operative versus non. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6, 7, although this method can present unsatisfactory results, such as. For periarticular fractures of distal humerus see elbow. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Transverse aug 07, 20 humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. A humeral shaft fracture results in a nonunion in less than 10% of cases, regardless of the technique used. After closed reduction, the fracture was stabilized by using a plate. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. 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. In the case of fractures of the proximal humerus, early range of motion is the main aim of treatment.
Modern concepts of internal fixation of long bone shaft fractures advocate. A custommade prefabricated brace was applied for the functional treatment of 21 isolated, closed, distal third humeral shaft fractures of 21 patients 17 male and 4 female. The objective of the present study was to determine the effectiveness of functional treatment for distal third humeral shaft fractures in young adults. Acute and chronic humeral shaft fractures in adults. Humerus shaft fracture an overview sciencedirect topics. 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. Functional treatment of closed humeral shaft fractures. The brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Only few cases are reported in the english literature till date having anterior dislocation of shoulder and ipsilateral closed humeral shaft fracture.
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