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HWN Suggests

Nothing Humorous About This Fracture

One of the remarkable characteristics of humerus fractures is their dramatic radiographic appearance. We are often alarmed when our orthopedic colleagues seem to minimize these fractures or recommend non-operative treatment. A hanging cast, sling and swathe, coaptation splint, or simple sling all seem like ridiculously simple treatment options.

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 Humeral Shaft Fracture

Humeral shaft fractures are common and account for 3% of all fractures. Even though the majority of these fractures are unstable, they typically do well with non-operative management Humeral shaft fractures can be immobilized with a hanging arm cast or a coaptation splint. The splint will start from the axilla, wrap around the elbow which should be flexed to 90 degrees, and extend over the acromion process. Utilize a valgus mold to counter the typical varus displacement. Support the wrist with a collar and cuff sling, while keeping the elbow unsupported to provide traction.

Articles of Interest

More Than Just a Shoulder Dislocation?

Two-part fractures with greater tuberosity displacement > 5mm are operative because of increased risk of functional impairment without any surgical intervention.

A Case of Arm Pain

Immobilize with a hanging arm cast or a coaptation splint. The coaptation splint will start from the axilla, wrap around the elbow which should be flexed to 90 degrees, and extend over the acromion process. Utilize a valgus mold to counter the typical varus displacement. Support the wrist with a collar and cuff sling, while keeping the elbow unsupported to provide traction.

Humeral Shaft Fracture

The shaft can break near the top of the bone, in the middle, or near the bottom of the bone. Depending on how and where your bone breaks, different treatments are needed.

Interventions for treating proximal humeral fractures in adults

There is high‐ or moderate‐certainty evidence that, compared with non‐surgical treatment, surgery does not result in a better outcome at one and two years after injury for people with displaced proximal humeral fractures. It may increase the need for subsequent surgery. The evidence is absent or insufficient for people aged under 60 years, high‐energy trauma, two‐part tuberosity fractures or less common fractures, such as fracture dislocations and articular surface fractures.

Occult Shoulder Injuries and Proximal Humerus Fractures

In this EM Cases main episode podcast Occult Shoulder Injuries and Proximal Humerus Fractures, Dr. Arun Sayal and Dr. Dale Dantzer answer questions such as: What should be included in the list of key occult shoulder injuries that we should have in our back pockets when faced with a patient who has injured their shoulder and the x-ray appears normal?

Proximal Humerus Fracture

Most common fracture affecting the shoulder girdle in adults 80% of all humeral fractures (Rockwood 1996). 5% of all fractures presenting to the ED (Vachtsevanos 2014).

Proximal Humerus Fractures

Fracture of the proximal humerus is a common injury often seen in older patients and one of the true osteoporotic fractures. Proximal humerus fracture (PHF) includes all fractures to the anatomical neck, surgical neck, greater tuberosity (GT), or lesser tuberosity, either isolated or in combination.

Self-Reduction in Proximal Humerus Fractures through Upright Patient Positioning: Is It up to Gravity?

The self-reduction in proximal humerus fractures (PHFs) remains a poorly explored myth, and it was rarely investigated in the past. One of the oldest hypotheses suggests that gravity and the weight of the affected arm alone are driving forces, which facilitate a self-reducing potential in PHFs. However, thus far, clear radiographic evidence for this theory is missing in the literature.

The FISH RCT: Surgical vs Non-Surgical Management of Displaced Humeral Shaft Fractures

The non-operative approach has been the standard but, the rate of surgery has markedly risen in the last decade (Schoch 2017). Operative management appears to reduce the risk of nonunion significantly but, comes with other risks including infections and iatrogenic radial nerve injuries. In the absence of high-quality evidence, marked practice variation persists.

Resources

StatPearls

Humerus fractures account for 4 to 6 percent of all fractures in young patients and 1 to 3 percent of all fractures in elderly patients. In young men, these fractures are usually a result of high-energy trauma while in the older population, these fractures are typically seen in women after a ground-level fall. Interestingly, humerus shaft fractures in polytrauma patients are independent predictors of intra-abdominal injury, long bone, and hand fractures.