Humeral shaft fracture and radial nerve palsy in Korean soldiers: focus on arm wrestling related injury

Abstract

IntroductionHumeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm wrestling, in young Korean soldiers and examined whether humeral fracture is related to demographic characteristics and the presence of radial nerve palsy.MethodsWe reviewed 7.5 years (July 2012 to June 2019) of medical records covering patients who had experienced a humeral shaft fracture after entering military service and had received surgery for open reduction and internal fixation. Data were obtained on basic demographics, initial event provoking the fracture, presence of radial nerve palsy, initial and follow-up severity of the weakness, and any discharge from military service because of prolonged radial nerve palsy.ResultsOf 123 cases, arm wrestling was the leading cause (52.8%). A high energy injury, such as falling from a height (11.4%), and sports related slips (10.6%) were other causes. All humeral shaft fractures caused by forceful contraction were spiral, while 40% of the fractures caused by external force related events were of a transverse type. The percentage of left-sided fractures was significantly higher for fractures arising from an external force than in those caused by forceful contraction related events. Radial nerve palsy was found in 34 patients (27.6%), and 16 were discharged from the military because of prolonged radial nerve palsy 6 months after the fracture. The causative events and other factors did not affect the presence of radial nerve palsy.ConclusionArm wrestling was the leading cause of humeral fracture in young Korean soldiers but the chance of developing comorbid radial nerve palsy did not differ from that of other causes. These epidemiologic findings in this young active group may help in understanding the causes of humeral shaft fracture in soldiers and in the wider young population.

Arm Wrestling Related Injuries: A Literature Review

“…subscapularis, pectoralis, and latissimus dorsi muscles in the shoulder, which are resisted by an opponent's external rotation force or another counter force [7]. Also, forceful elbow flexion and shoulder internal rotation may lead to fracture of a spiral nature have been reported in the literature [8,9]. According to some authors, pure rotator force without axial load on the humerus causes spiral fracture only, while axial load and rotator force can cause a butterfly fragment [10].…”

“…The patients with humerus fracture ranged in age from 22 to 48-years-old, average of 31.2 years [12]. Also, it was reported that the cases mean (± SD) age was 21.7 ± 3.9 years in another study [9].…”

“…Fractures of the humeral shaft may occur at any age in anyone engaging in this type of sport [2,9,19]. The patients with humerus fracture ranged in age from 22 to 48-years-old, average of 31.2 years [12].…”

“…It has been reported that fractures mostly occur in the right arm and left side of the right arm [9].…”

“…In another study, it was reported that humeral fracture caused by arm wrestling was seen in 30 cases in the general population [13]. In another study conducted with 123 young soldiers who had humerus shaft fractures in 2020, it was reported that arm wrestling was the cause of the fracture in 65 (52.8%) of the cases [9].…”