Of a total of 14 neck fractures in a series of 152. Radius and ulna fractures are more common in men than in women because they are more often to be in motor vehicle accidents or play sports that contribute to getting forearm fractures of the radius and ulna. The study included 8 humeral shaft fracture patients. Outcome of nonoperative vs operative treatment of humeral.
This represents a growing public health concern in a climate of cost containment. Humeral shaft fractures account for % of all fractures and approximately 20% of all humeral fractures. This fracture is a hallmark of nonaccidental injury. Fracture care for the community orthopedist william w. Based on such needs, zuckerman and koval9 indicated surgical treatment in cases of exposed fracture, associated vascular injuries, floating.
A patient with a galeazzi fracture will present not only with pain in the forearm where the radius is broken, but also swelling, tenderness, and pain at the wrist where there is a dislocation of the distal radioulnar joint. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. A humeral shaft fracture is an injury that can lead to serious complications and a debilitating recovery. Nonoperative treatment with functional bracing has been regarded as the golden standard for treatment of closed humeral shaft fractures with studies reporting a high overall healing rate and an acceptable functional outcome. Although intramedullary nailing imn is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60. Shaft fracture was classified as simple transverse fracture ao classification a31. Humeral shaft fractures extending to the proximal or distal shaft, small or deformed medullary canal or open growth plate. It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants 2 with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. To code a diagnosis of this type, you must use one of the eight child codes of s42. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Minimally invasive plating osteosynthesis for middistal.
Ulnar and radial shaft fractures musculoskeletal medicine. Previous studies published concerns over whether this technique had higher complication rates. Functional bracing of fractures of the shaft of the humerus. Although they occur in all age groups, a bimodal distribution is noted.
Humeral shaft fractures musculoskeletal medicine for. The brace is typically applied 5 to 7 days postinjury, following a short period of coaptation splinting figure 1. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. Unfortunately, there are limited level1 studies to guide the management of isolated ulnar shaft fractures. It has been estimated that around 60 new cases of hsf in adults are treated per year, for every group of 600,000 inhabitants with regard to location, the middle third of the right shaft is the region most affected, and type a of the ao classification occurs most frequently, while.
The incidence of humeral shaft fractures has been increasing over time. The 2 groups were similar in terms of fracture patterns, fracture location, age, and associated injuries. Hello, im ed smith, a sacramento bone fracture lawyer. Two classification systems are commonly used for shoulder arthroplasty periprosthetic fractures of the humeral shaft.
Humeral shaft fractures were identified by the international classification. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus 1. If you or a loved one has been injured in a traumatic accident, please call me at 916 9216400 or 800 4045400 for friendly and free advice. These fractures have an annual incidence from to 14. There has been no report on the fracture pattern, complications and surgical outcomes regarding ipsilateral humeral neck and shaft fracture in the literature, nor suggested fracture mechanism.
The humerus is the long bone of the arm and has several different parts to it. Humeral shaft fractures pediatric orthopaedic society of. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age. The concomitant shaft fracture is often comminuted and or open and is thought to absorb the majority of the force decreasing the forces across the neck explaining the less likelihood of displacement versus isolated neck of femur fractures 4. The head of the humerus is the ball and socket joint that makes up the shoulder. Fracture of the ipsilateral neck of the femur in shaft nailing. There is an increasing trend in the literature to perform operative fixation of these fractures. Femoral shaft fractures orthopaedic trauma association.
Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. Intraoperative measurements included blood loss and operative time. Timing of femoral shaft fracture fixation affects length of hospital. A radial shaft fracture with distal radial ulnar joint druj instability is known by its eponym, the galeazzi fracture. Humeral shaft fractures accounts for 35% of all fractures and are associated with great risk of radial nerve injury which is situated in spiral groove in posterior aspect of humerus. The most useful rehabilitation protocol is the threephase system. Fractures of the shaft of the humerus account for 1% to 3% of all fractures and approximately 20% of all fractures involving the bone,4 but little is known about their epidemiology. Some people get hurt playing sports while other people just slip and fall. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Most humeral shaft fractures unite if left alone in the same room. Good or excellent outcomes are reported in 85% to 95% of patients.
However, good surgical outcomes can be achieved with proper patient selection. There is a bimodal distribution with peaks primarily in young male patients, 2 years of age, and a larger peak in older females from 6080 years of age 4. A young adult sustained a closed, shortened fracture of the distal ulnar shaft. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Distal fractures including intraarticular fractures will be included in chapter 11. Displacement was 30% of the ulnar diameter at the fracture level on ap radiogrpah and 60% on the lateral. Proximal humeral fractures were discussed in chapter 9. Pdf intramedullary nailing of humeral shaft fractures. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft.
Historically, the treatment of choice has been functional bracing. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Only pape j trauma 1993 has shown a deleterious pulmonary effect to immediate reamed intramedullary nailing in. Mechanism of injury there are several unique features of the humerus that. Humeral shaft fractures account for 1 to 3% of all fractures in adults 1, 2 and for 20% of all humeral fractures. May 08, 2012 humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Nonoperative treatment is still the standard treatment for isolated humeral shaft fractures 6, 7, although this method can present unsatisfactory results, such as. The incidence of osteonecrosis in ipsilateral femoral neck and shaft fractures is also less than that. Humeral shaft fractures humeral shaft fractures account for 3% to 5% of all skeletal fractures. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Treatment of the humeral shaft fractures minimally. Review article management of humeral shaft fractures.
Surgical options include external fixation, open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and antegrade or retrograde intramedullary nailing. Classification no universally accepted system for humeral shaft fractures anatomical proximal shaft, middle shaft, or distal shaft. Humeral shaft fractures account for 3% of overall fractures. Fortythree percent to 69% of fractures involve the mid shaft. The humeral shaft is the region just proximal to the supracondylar ridge and immediately distal to the surgical neck. Modern concepts of internal fixation of long bone shaft fractures advocate. Immediate elbow and wrist range of motion rom is essential for successful therapy with a functional fracture brace. Jun 19, 2016 throwing motions, and violent muscle contractions can also cause humeral shaft fractures.
Compression plating versus intramedullary nailing of humeral shaft fracturesa metaanalysis. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Many people have experienced a broken arm due to multiple causes. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. Secondary radial nerve palsy was reported in 3 cases, 1 of which had reexploration via the posterior approach.
Fractures of the shaft of the humerus semantic scholar. It may also result following lowenergy injury or fall in patients with significant osteoporosis or. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. This fracture occurred over the distal third of the shaft of the humerus. Humeral shaft fracture radiology reference article. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures.
Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma. The incidence is thought to be between 12 and 30 per 100,000 per year. Surgical treatment is reserved for specific conditions. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. If a fracture or fracture repair is stable, then therapy should be started early. It is perhaps the easiest of the major long bones to treat by conservative methods. A fracture of the shaft of the humerus is one of the most common bone fractures that people can develop in a car accident. Introduction fractures of the proximal humerus or shaft are common. Humeral shaft diaphysis can fracture following injury to the arm due to a direct fall or blow, automobile injury, gun shot wound, missile injury, and rarely, due to ballthrowing injuries. Displacement was 30% of the ulnar diameter at the fracture level on. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail.
Fractures should be described by location as proximal, middle, distal, or at the junction of the proximal and middle thirds or middle and distal thirds holsteinlewis fracture, see chapter 2. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Although the fracture line extends into the greater tuberosity, there is no significant displacement or angulation. The radius and ulna are the two long bones of the forearm that allow the hand and wrist to move as well as take part in elbow function.
Includes diaphyseal fractures of distal third of humerus. The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to the midshaft. Humeral shaft fractures with primary radial nerve palsy. Intramedullary nailing imn is an accepted technique for the treatment of humeral shaft fractures. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Humeral shaft fractures represent approximately 15 % of all fractures, occurring over 70,000 times a year in north america. Isolated ulnar shaft fractures, although seemingly benign, may be complicated by nonunion, radioulnar synostosis, and loss of motion. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. The humeral shaft supplies the attachment for a number of powerful muscles.
Bone grafting alone as a treatment of a failed union of a femoral shaft fracture cannot be recommended. Mar 03, 2017 a fracture of the shaft of the humerus is one of the most common bone fractures that people can develop in a car accident. The pdf of the article you requested follows this cover page. Humeral shaft fractures are the second most common birth fracture. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function.
The overall incidence of humeral fractures was 104. Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. Cross iii, md assistant professor vice chair, department of orthopedic surgery chair, division of community orthopedic surgery division of orthopedic trauma rochester, mn 2014 mfmer slide2 disclosures i have no disclosures. Surgical results of open reduction and plating of humeral. Mechanism of injury fracture at the deltoid insertion with adduction of the proximal fragment due to pectoralis muscle forces fracture distal to the deltoid insertion with abduction arrow of. Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. Recent technical advances such as angular stable plate and nail constructs lead to a shift in the treatment algorithm for this type of fracture. Rehabilitation guidelines for proximal humerus fracture non operative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf.
Humeral shaft fractures hsfs are one of the most common injuries in trauma centers. Humeral shaft fractures hsfs represent 3% of the fractures of the locomotor apparatus. The first is the wright and cofield classification system, which is based on the location of the fracture in relation to the tip of the humeral stem. Treatment of the humeral shaft fractures minimally invasive. For periarticular fractures of distal humerus see elbow. Femoral shaft fractures are an emergency indication and should be promptly stabilized as delayed stabilization is associated with increased morbidity, particularly in the lungs and a longer hospital stay 9. It may also result following lowenergy injury or fall in patients with significant osteoporosis or skeletal metastases. Physiologically induced motion at the fracture site favors healing of the fracture. Comparison of outcome of femoral shaft fracture fixation with. Intramedullary nailing intramedullary nailing imn is the goldstandard in treating patients with femoral shaft fractures figs 1 and 2.
735 412 1026 1498 135 228 1458 834 248 397 926 482 861 58 960 1455 1487 811 294 555 1628 894 283 517 618 1150 1477 1090 275 11 1491 827 322 308 1354 289 1259 1045 897 738 1187 1214 1246 1241 382 65 1388