Humeral Shaft Fractures

Abstract

The majority of humeral shaft fractures are successfully managed nonoperatively. Indications for surgery include open fractures, associated adjacent articular fractures, ipsilateral forearm fractures, vascular injuries requiring repair, and those with nerve injuries due to high-energy penetrating trauma. Polytrauma patients requiring recumbent positioning are better served with fixation of the humerus. Patients with associated pelvic or lower extremity injuries may use a stabilized humerus shaft for weight bearing. The radial nerve should be identified and protected during reduction and fixation. Plate fixation is effective via anterolateral, lateral, or posterior approaches with the posterior approach favored for distal fractures. Large fragment plate fixation is most common. Shortening of up to 3 cm is acceptable and without resultant dysfunction, if needed to address extensive comminution or bone loss. Intramedullary nails may be advantageous for pathological fractures secondary to neoplasm as well as for segmental fractures. Meticulous dissection of the starting point and protection of the rotator cuff will minimize subsequent shoulder pain. Interlocking bolts should be placed through incisions and with instruments that permit protection of adjacent nerves.