• Clinical science

Humerus fracture

Summary

Humerus fractures can result from direct or indirect trauma. They are classified according to their location as proximal, humeral shaft, or distal fractures. Proximal humerus fractures commonly occur in the elderly, while distal supracondylar fractures are the most common type of fracture in the pediatric population. Patients may present with localized pain, swelling, and deformities. Conservative treatment (splinting, casting, and physical therapy) often suffices for nondisplaced, closed fractures. While arteriovenous complications and displaced or open fractures usually require surgical treatment.

Epidemiology

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Direct or indirect trauma
    • Falls with axial loading on an outstretched hand (most common cause) [1]
    • Motor vehicle accidents
    • Violent seizures
    • Direct blow to the back of the humerus
  • Pathologic fractures: e.g., Paget disease, metastatic bone disease (less common)

Classification

Clinical features

  • Severe local pain: exacerbated during palpation or movement at shoulder or elbow
  • Local swelling (edema or bleeding), deformity, and/or crepitus
  • Shortening of the arm (associated with displacement)
  • Neurovascular complications such as radial nerve palsy (see “Complications” below)
  • See “Signs of fracture.”

The radial nerve runs through the radial sulcus of the upper arm and is especially at risk in fractures of the middle third (midshaft) of the humerus!

Diagnostics

Treatment

Conservative therapy

  • Indication: nondisplaced, closed fractures
  • Procedures
    • Hanging-arm cast or coaptation splint and sling for approx. one to two weeks with subsequent follow‑up x‑ray and brace
    • Early physical therapy to restore function

Surgical treatment

Open fractures require irrigation and prophylactic antibiotic therapy.

Complications

Humerus fracture nerve palsies
Nerve Motor function Sensory function Associated site of humerus fracture
Axillary
Radial
Ulnar
Median
  • ↓ Sensation over thenar eminence and over lateral 3½ fingers (first 3½ digits, beginning with the thumb)

“Broken ARM:“ Axillary, Radial, and Median nerves can be injured.

Injuries to the median nerve and brachial artery, which both cross the elbow, are common complications of supracondylar fractures.

We list the most important complications. The selection is not exhaustive.

  • 1. Pencle FJ, Varacallo M. Proximal Humerus Fracture. StatPearls. 2020. pmid: 29262220.
  • 2. Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat Res. 2013; 471(1): pp. 39–43. doi: 10.1007/s11999-012-2454-9.
  • 3. Popkin CA, Rosenwasser KA, Ellis HB Jr. Pediatric and Adolescent T-type Distal Humerus Fractures. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews. 2017; 1(8): p. e040. doi: 10.5435/JAAOSGlobal-D-17-00040.
  • 4. Dey Hazra RO, Lill H, Jensen G, Imrecke J, Ellwein A. Fracture-pattern-related therapy concepts in distal humeral fractures. Obere extremitat. 2018; 13(1): pp. 23–32. doi: 10.1007/s11678-018-0442-8.
  • Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6): pp. 1077–89. pmid: 5455339.
last updated 11/19/2020
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