Humeral shaft fractures

Abstract

Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

Functional outcome of antegrade interlocking intramedullary nailing for humeral shaft fractures

“…Function of the upper extremity is not affected even when there is up to 20º of anterior angulation, 30º of varus angulation, 15º of malrotation, and 3 cm of shortening of the humerus, which is the guide to continued conservative management. 1 Majority of uncomplicated humeral shaft fractures can be managed non-operatively, with an expected union rate of more than 90% and continues to be the mainstay of treatment still. 1 Methods include functional bracing, hanging-arm casts, modified Velpeau dressings, coaptation splints, shoulder spica casts, and abductiontype splints.…”

“…1 Majority of uncomplicated humeral shaft fractures can be managed non-operatively, with an expected union rate of more than 90% and continues to be the mainstay of treatment still. 1 Methods include functional bracing, hanging-arm casts, modified Velpeau dressings, coaptation splints, shoulder spica casts, and abductiontype splints. Sarmiento et al in 1977 described functional cast bracing with a moldable splint which allowed early return to activity, acceptable functional outcomes, and minimal morbidity.…”

“…of soft tissues from the bone, increased blood loss, disruption of the periosteal blood supply, a longer operating time, risk of injury to radial nerve, and difficulty with complex fracture patterns and in osteoporotic bones, the possible need for plate removal at a later date are described as negative features for plate fixation. 1,10,12 IMN stabilization offers an approach requiring less extensive dissection, minimal soft tissue disruption preserving the fracture hematoma, less blood loss, shorter operative times, and a lower incidence of serious complications such as radial nerve palsy. Recently many authors in prospective randomized studies, comparing IMN versus locking compression plates in treatment of humeral Shaft Fracture found intraoperative blood loss, operative time, hospital stay and average union time) were significantly lower in patients treated with IMN and no significant difference between the two groups in terms of union rate, shoulder function or complications.…”

“…1 Most humeral diaphysis fractures are simple patterns of the mid-diaphysis These fractures have potential to cause significant disability in the young which is often temporary and in the old often permanent disability.…”

Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

“…Surgical management is generally accepted for open fractures, neurovascular injuries, polytrauma patients, ipsilateral articular fractures, obese patients and fractures that fail nonsurgical management [3]. But currently, patient demands for greater comfort provided by unrestricted and early mobilisation without casting, meant that this treatment option attracted a lot of interest [15]. Moreover, there are studies reporting disadvantages of non-operative treatment with higher rates of nonunion in certain fracture patterns and loss of reduction compared to operative management [16].…”