Humeral shaft fractures

Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90 % union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

[1]  L. Klenerman.  Fractures of the shaft of the humerus. , 1966, The Journal of bone and joint surgery. British volume.

[2]  W. Grechenig,et al.  Anatomical basis of the risk of radial nerve injury related to the technique of external fixation applied to the distal humerus , 2010, Surgical and Radiologic Anatomy.

[3]  G. Zych,et al.  Functional Bracing for the Treatment of Fractures of the Humeral Diaphysis* , 2000, The Journal of bone and joint surgery. American volume.

[4]  A. Hollister,et al.  New technique for humerus shaft fracture retrograde intramedullary nailing. , 2011, Techniques in hand & upper extremity surgery.

[5]  S. Nijs,et al.  Operative treatment of humeral shaft fractures. Comparison of plating and intramedullary nailing. , 2010, Acta orthopaedica Belgica.

[6]  C. Luo,et al.  Minimally invasive plating for complex humeral shaft fractures , 2007, Archives of Orthopaedic and Trauma Surgery.

[7]  Yoshinobu Watanabe,et al.  Early Full Range of Shoulder and Elbow Motion is Possible After Minimally Invasive Plate Osteosynthesis for Humeral Shaft Fractures , 2010, Journal of orthopaedic trauma.

[8]  B. French,et al.  Plating of Acute Humeral Diaphyseal Fractures Through an Anterior Approach in Multiple Trauma Patients , 2012, Journal of orthopaedic trauma.

[9]  G. Tytherleigh-Strong,et al.  The epidemiology of humeral shaft fractures. , 1998, The Journal of bone and joint surgery. British volume.

[10]  T. Wallny,et al.  Functional treatment of humeral shaft fractures: indications and results. , 1997, Journal of orthopaedic trauma.

[11]  A. Sarmiento.  Functional bracing of fractures of the shaft of the humerus , 2008 .

[12]  D. Hak,et al.  Safety and Efficacy of Conversion from External Fixation to Plate Fixation in Humeral Shaft Fractures , 2010, Journal of orthopaedic trauma.

[13]  S. Ponzer,et al.  Primary Radial Nerve Palsy in Patients With Acute Humeral Shaft Fractures , 2008, Journal of orthopaedic trauma.

[14]  W. Obremskey,et al.  Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. , 2010, Orthopedics.

[15]  D. Zlotolow,et al.  Surgical Exposures of the Humerus , 2006, The Journal of the American Academy of Orthopaedic Surgeons.

[16]  K. Hamoud,et al.  External fixation for severe open fractures of the humerus caused by missiles. , 1997, Journal of orthopaedic trauma.

[17]  M. Prasarn,et al.  Erratum: Dual plating for fractures of the distal third of the humeral shaft (Journal of Orthopaedic Trauma (2011) 25 (57-63)) , 2013 .

[18]  K. Singisetti,et al.  Nailing versus plating in humerus shaft fractures: A prospective comparative study , 2010, International Orthopaedics.

[19]  P. Rommens,et al.  Humeral nailing revisited. , 2008, Injury.

[20]  C. Gerber,et al.  The results of functional (Sarmiento) bracing of humeral shaft fractures. , 2002, Journal of shoulder and elbow surgery.

[21]  G. Zych,et al.  Diaphyseal fractures of the humerus. Treatment with prefabricated braces. , 1988, The Journal of bone and joint surgery. American volume.

[22]  K. An,et al.  Reduction of triceps muscle force after shortening of the distal humerus: a computational model. , 1997, Journal of shoulder and elbow surgery.

[23]  M. Bhandari,et al.  Plate fixation or intramedullary fixation of humeral shaft fractures , 2010, Acta orthopaedica.

[24]  W. Mills,et al.  Lateral approach to the humeral shaft: an alternative approach for fracture treatment. , 1996, Journal of orthopaedic trauma.

[25]  P. Streubel,et al.  Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible? , 2010, International Orthopaedics.

[26]  A. Sarmiento.  THOUGHTS ON THE IMPACT OF TECHNOLOGY ON ORTHOPAEDICS , 2000 .

[27]  M. Mighell,et al.  Humeral shaft fractures: a review. , 2011, Journal of shoulder and elbow surgery.

[28]  K. Strømsøe,et al.  Functional results of braced humeral diaphyseal fractures; why do 38% lose external rotation of the shoulder? , 2000, Archives of Orthopaedic and Trauma Surgery.

[29]  Dameron Tb,et al.  Humeral shaft fractures in adults. , 1981 .

[30]  D. Lorich,et al.  Dual Plating for Fractures of the Distal Third of the Humeral Shaft , 2011, Journal of orthopaedic trauma.

[31]  P. Tornetta,et al.  Open Fractures of the Humerus Treated With External Fixation , 1997, Clinical orthopaedics and related research.

[32]  Stig Brorson,et al.  Management of Fractures of the Humerus in Ancient Egypt, Greece, and Rome: An Historical Review , 2009, Clinical orthopaedics and related research.

[33]  H. Peiyan,et al.  Minimally Invasive Plating Osteosynthesis (MIPO) of Middle and Distal Third Humeral Shaft Fractures , 2007, Journal of orthopaedic trauma.

[34]  J. Boyes,et al.  Turret exostosis. Ossifying hematoma of the phalanges. , 1966, The Journal of bone and joint surgery. American volume.

[35]  M. Bhandari,et al.  Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis , 2006, Acta orthopaedica.

[36]  C. Iacobellis,et al.  Locked antegrade intramedullary nailing of humeral shaft fractures , 2012, MUSCULOSKELETAL SURGERY.

[37]  M. Rutgers,et al.  Treatment of Diaphyseal Fractures of the Humerus Using a Functional Brace , 2006, Journal of orthopaedic trauma.

[38]  Robert M Szabo,et al.  Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008 , 2012, Arthritis care & research.

[39]  M. Gardner,et al.  Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. , 2008, Journal of orthopaedic trauma.

[40]  J. Stannard,et al.  Surgical Treatment of Orthopaedic Trauma , 2007 .

[41]  P. Rommens,et al.  [Retrograde nailing of humerus shaft fractures with the unreamed humerus nail. An international multicenter study]. , 1998, Der Unfallchirurg.

[42]  S. Ponzer,et al.  Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. , 2006, The Journal of bone and joint surgery. British volume.

[43]  A. Sarmiento.  Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. , 2011, Orthopedics.

[44]  M. Järvinen,et al.  Functional treatment of closed humeral shaft fractures , 2005, International Orthopaedics.

[45]  B. Simmen,et al.  Does Weber's rotation osteotomy induce degenerative joint disease at the shoulder in the long term? , 2007, Journal of shoulder and elbow surgery.

[46]  P. Rommens,et al.  Retrograde nailing of humeral shaft fractures with the UHN. An international multicenter survey , 1998, Der Unfallchirurg.

[47]  J. Marsh,et al.  External fixation of open humerus fractures. , 1999, The Iowa orthopaedic journal.

[48]  G. Zych,et al.  Salvage of Humeral Nonunions With Onlay Bone Plate Allograft Augmentation , 2001, Clinical orthopaedics and related research.

[49]  T. Maeda,et al.  Does the location of the entry point affect the reduction of proximal humeral fractures? A cadaveric study. , 2011, Injury.

[50]  D. Ring,et al.  Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. , 2006, The Journal of bone and joint surgery. American volume.

[51]  S. Hansen.  Rockwood and Green's Fractures in Adults. 6th ed. , 2007 .

[52]  C. Wijdicks,et al.  The operative treatment of diaphyseal humeral shaft fractures. , 2007, Hand clinics.

[53]  A. Weiland,et al.  Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis. With Reference to the Radial Nerve* , 1996, The Journal of bone and joint surgery. American volume.

[54]  S. Curtiss,et al.  Crutch Weightbearing on Comminuted Humeral Shaft Fractures: A Biomechanical Comparison of Large versus Small Fragment Fixation for Humeral Shaft Fractures , 2011, Journal of orthopaedic trauma.

[55]  M. Bhandari,et al.  Treatment of humeral shaft fractures–meta-analysis reupdated , 2010, Acta orthopaedica.