Medical Minute Recap: Humeral Shaft Fractures

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September 22, 2015 by dailybolusoflr

By: Karolina Paziana, MD

Location determines deformity:

  • Fx proximal to pectoralis major insertion: proximal fragment will be abducted and externally rotated due to unopposed rotator cuff action – DIFFICULT TO REDUCE
  • Fx proximal to deltoid but distal to pec insertion: Pull fragments in opposite directions
  • Fx distal to deltoid insertion: proximal fragment is abducted by deltoid, distal fragment shortens due to biceps and triceps contraction.
  • Holstein Lewis Fx: distal 1/3 of humerus, where radial nerve spirals posteriorly. High incidence of radial nerve palsy. 

Neurovascular Concerns:
  • Most common nerve injury – RADIAL NERVE (10-18% of humeral shaft fx)
  • Most common nerve deficits: inability to extend the thumb or wrist + decreased sensation over hand dorsum
  • Neurological Exam:
  • Median & Ulnar nerve motor and sensory
  • Triceps function (will not displace fx)
  • Hitchhiker sign
  • Wrist extension
  • Sensation of the hand (dorsum – thenar web space)

Emergency Surgery: Open Fractures, Compartment Syndrome, Vascular Injury

Admission for Surgery
  • Floating Elbow
  • Segmental Fractures
  • Displaced intra-articular fx
  • Bilateral humeral fractures
  • Progressive neurologic injury
  • Post-rdx neurovascular injury
  • Pathologic fxs
  • Inability to reduce

Delayed Surgical Management (after DC home):
  • Poor pain tolerance
  • Inability to perform ADLs
  • Delayed nerve palsy
  • Non-union
  • Delayed Union
  • Loss of reduction

Ortho Consult: Displaced/angulated fractures, nerve palsy

Reduction: Rotational deformity, >30 degrees varus angulation or >2cm shortening.

Discharge Planning: Ortho f/u w/in 1 week, pain control, immobilization. REASSURANCE.

Courtney C. Nothing Humorous About This Fracture. Emergency Physician Monthly July 2015 Vol 22:7. Accessed July 4, 2015.

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