Humeral Shaft Fracture: Causes, Symptoms & Treatment
A humeral shaft fracture is a break in the middle section of the upper arm bone. It often results from trauma or a fall and may injure the radial nerve, causing temporary weakness.
Things worth knowing about "Humeral shaft fracture"
A humeral shaft fracture is a break in the middle section of the upper arm bone. It often results from trauma or a fall and may injure the radial nerve, causing temporary weakness.
What is a Humeral Shaft Fracture?
A humeral shaft fracture is a break in the diaphysis (shaft) of the humerus -- the long bone of the upper arm located between the shoulder and elbow joints. These fractures account for approximately three to five percent of all adult fractures. They can occur at any age, but older individuals with osteoporosis are at particularly increased risk.
Causes
Humeral shaft fractures result from a variety of injury mechanisms:
- Direct trauma: A direct blow to the upper arm, commonly seen in road traffic accidents or sports injuries.
- Indirect trauma: A fall onto an outstretched hand or elbow, transmitting force indirectly to the shaft.
- Torsional mechanism: Rotational forces on the arm, such as those occurring in arm wrestling or throwing sports, can cause spiral fractures.
- Pathological fracture: Bone weakened by osteoporosis, bone metastases, or primary bone tumors may fracture with minimal force.
Symptoms
Common signs and symptoms of a humeral shaft fracture include:
- Severe pain in the upper arm, worsened by movement
- Swelling and bruising (hematoma) at the fracture site
- Visible deformity or abnormal alignment of the upper arm
- Limited range of motion at the shoulder and elbow
- Possible radial nerve palsy: weakness or numbness in the forearm, wrist, or fingers due to injury of the radial nerve, which runs in close proximity to the humeral shaft (Holstein-Lewis fracture pattern)
Diagnosis
Diagnosis involves a combination of clinical assessment and imaging studies:
Clinical Examination
The physician takes a detailed history of the injury and examines the arm for swelling, deformity, point tenderness, and neurovascular function -- particularly the integrity of the radial nerve, assessed by checking wrist and finger extension.
Imaging
- X-ray: Standard anteroposterior and lateral radiographs are the first-line imaging method and allow assessment of fracture type, location, and displacement.
- Computed Tomography (CT): Used for complex fractures or when surgical planning requires more detailed information about fragment position.
- MRI: Reserved for suspected soft tissue injuries or pathological fractures.
Treatment
Treatment depends on fracture pattern, degree of displacement, associated injuries, and patient condition.
Conservative (Non-Surgical) Treatment
Many humeral shaft fractures are managed non-operatively, as the humerus tolerates a degree of malalignment well and is surrounded by muscles that aid stabilization:
- Hanging cast or functional brace (Sarmiento brace): Immobilizes the fracture while allowing early mobilization of the elbow and shoulder.
- Physiotherapy: Early rehabilitation exercises are essential to prevent muscle atrophy and joint stiffness.
Surgical Treatment
Surgery is indicated in the following situations:
- Open fractures (bone fragment piercing the skin)
- Associated vascular or nerve injuries
- Significant displacement not correctable by conservative means
- Multiple trauma (polytrauma)
- Pathological fractures
Surgical options include intramedullary nailing, plate osteosynthesis (open reduction and internal fixation with a plate and screws), and in rare cases, an external fixator.
Healing and Prognosis
Most humeral shaft fractures heal within 8 to 16 weeks. The overall prognosis is good. An associated radial nerve palsy, which occurs in up to 18 percent of cases, resolves spontaneously in the majority of patients over several weeks to months. Physiotherapy plays a key role in restoring full strength and range of motion during rehabilitation.
References
- Rockwood C.A., Green D.P. et al. - Rockwood and Green's Fractures in Adults, 8th edition, Lippincott Williams & Wilkins, 2015.
- Sarmiento A. et al. - Functional bracing of fractures of the shaft of the humerus. Journal of Bone and Joint Surgery, 2000; 82(4): 478-486. PubMed PMID: 10761938.
- Walker M. et al. - Humerus shaft fractures. Journal of the American Academy of Orthopaedic Surgeons, 2011; 19(11): 655-663. PubMed PMID: 22051282.
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