Humeral shaft fractures

by Ntambue Kauta & Stephen Roche

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Introduction

Humeral shaft fractures are fractures extending from below the surgical neck to the supracondylar ridge. The mechanism of injury may be a high energy impact (falls from height, road accidents) or low energy impacts, such as a fall from standing height or trivial trauma as in pathological fractures.

Clinical assessment

• Observe the advanced trauma life support (ATLS) approach for all high energy impact patients.
• Examine and document the neurovascular status, most notably, the radial nerve.
• Document the status of the soft tissue envelop.

Management

Attempt conservative treatment in a U Slab for six weeks.

Acceptable position

• More than 50% apposition.
• Less than 30o valgus or varus deformity.
• Less than 30o anterior or posterior angulation.

Failure to achieve and maintain these position goals should dictate the surgical treatment of the fracture.

Absolute indications for surgery

• Open fractur
• Fracture with neurovascular injury requiring repair
• Failure of conservative treatment
• Nonunion
• Malunion

Relative indications for surgery

• Segmental fracture
• Pathological fracture
• Multiple fractures
• Ipsilateral shoulder or forearm fracture
• Other forms of soft tissue compromise
• Patient’s work or leisure requirements

Common complications of humeral shaft fracture

• Neurovascular injuries – high index of suspicion of radial nerve palsy is warranted for the distal third spiral fracture (Holstein Lewis fracture)
• Malunion
• Nonunion
• Joint stiffness