Listing a study does not mean it has been evaluated by the u. Fractures of the proximal humerus and humeral shaft are not common in children and usually results from injury. The objective of the present study was to determine the effectiveness of functional treatment for distal third humeral shaft fractures in young adults. Outcome after treatment of humeral shaft fractures. The humerus is the largest bone in the upper extremity. See stress fractures of the humeral shaft and proximal humeral fractures in adults.
Backgroundhumeral shaft fractures are common but debate still occurs as to. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Humeral stress fractures seldom occur, but there are case reports, particularly among overhead athletes, weightlifters, gymnasts, and rowers. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Clinical examination for fracture stability was routinely performed on patients by the treating physicians and documented it in the medical record. Dcp remains the best treatment for unstable fractures of the shaft of the humerus. Pdf nonoperative treatment of humeral shaft fractures.
Humeral shaft fractures were identified by the international classification. Dec 02, 2017 humeral shaft fractures 1 indications, nonop tx, surgical approaches ota lecture series iii u04a duration. Humeral shaft fracture radiology reference article. Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. The approximate location of the original humeral shaft medial calcar is. Jul 15, 2012 humeral shaftfractures conservative treatment 90% of humeral shaft fractures heal with nonsurgical management 20degrees of anterior angulation, 30 degrees of varus angulation and up to 3 cm of shortening are acceptable most treatment begins with application of a coaptation spint or a hanging arm cast followed by placement of a fracture brace. Humeral shaft fracture everything you need to know dr.
Before the start of mipo for humeral shaft fractures, the standard operation was orpo and. Management of humeral shaft fractures jama surgery. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side. Surgical treatment of humeral shaft fractures has nonetheless been greatly facilitated by the development of new implants. Nonoperative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Mar 07, 2020 the results of this treatment were excellent, in comparison to what little data are available describing treatment of open humeral shaft fractures with either intermedullary nails or with external fixation. Treatment of the humeral shaft fractures minimally invasive. Gartlands classification of supracondylar fracture of humerus. The cause of a humerus fracture is usually physical trauma such as a fall. In addition, the approach can be extended both proximally and distally, providing the surgeon a dynamic exposure to the. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Despite a long rehabilitation program physical activities will change and an avoidance of overhead activities will. For periarticular fractures of distal humerus see elbow.
Fractures of humeral shaft are common injuries, which make up 1 to 3 % of all fractures 15. The incidence of humeral shaft fractures has been increasing over time. There is an increasing trend in the literature to perform operative fixation of these fractures. Midshaft humerus fracture this information will guide you through the next 6 weeks of your rehabilitation. If a fracture or fracture repair is stable, then therapy should be started early. Splint the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Review article management of humeral shaft fractures. Pdf plate and screw fixation psf has always been the more common surgical treatment of humeral shaft fractures. Humeral shaft fractures pediatric orthopaedic society of. Each of these techniques has advantages and disadvantages, and the rate of fracture union may vary based on the technique used. Closed treatment of humeral shaft fractures represents an effective method of fracture management and has sustained critical evaluation throughout the literature. The humeral head is covered in articular cartilage and articulates. Return to sports after plate fixation of humeral head. Humeral shaft fractures in children under four years should lead the examiner to be alert for other signs of nonaccidental injury. The purpose of this study is to analyze national trends in surgical management of humeral shaft fractures and determine factors predictive of surgical intervention. Acute and chronic humeral shaft fractures in adults sciencedirect. Use the information below to gain a better understanding of your injury and what can be done to maximise your recovery. Nonstress humeral fractures are discussed separately.
Symptoms include pain, swelling, and a decreased ability to move the shoulder. Modern surgery favors treatment modalities that are minimally invasive, have low morbidity, and provide rapid. Most humeral shaft fractures unite if left alone in the same room. Proximal humerus fractures account for 6% of all fractures in the western world. Treatment of humeral shaft fractures by functional bracing has been reported to be effective in achieving high rate of fracture union and good function of the adjacent shoulder and elbow joints. A divergence of opinion exists in the literature between the values of imn and minimally invasive plating osteosynthesis for the treatment of middistal third humeral shaft fractures. This is certainly still the contemporary view but there is an obvious trend towards surgical stabilization. We help you diagnose your humeral shaft case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Use of titanium elastic nails in the adult diaphyseal humerus. Minimally invasive plate osteosynthesis vs conventional fixation. This treatment method has been the subject of controversy since its inception. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Good or excellent outcomes are reported in 85% to 95% of patients.
The incidence of these fractures has been increasing with the aging population. Ao handbooknonoperative fracture treatment executive editor. Clavicle fractures generally heal rapidly without specific treatment and without sequelae. Humerus and femur fractures occur infrequently and have an excellent prognosis for full healing. Patients with pd have a high risk of fracture even under low energy because of postural impairments. Compression plating versus intramedullary nailing of humeral shaft fractures.
This site does not host pdf files, does not store any files on its server, all document are the property of their respective owners. Open reduction and internal fixation of humeral shaft. A proximal humerus fracture is a break of the upper part of the bone of the arm. Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and. The proximal humerus is important because it forms half of the shoulder joint.
Humeral shaft fractures musculoskeletal medicine for. Fracture shaft of ulnar, together with disruption of the proximal radioulnar joint and dislocation of radiocapitallar joint fracture of base of the first metacarpal bone salterharris fracture fracture that involves the epiphyseal plate or growth plate of a bone type i. The aoota classification system is another commonly used system that groups fractures depending on whether the fracture is unifocal or bifocal, and whether or not the fracture goes through the articular surface. 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. Sometimes this type of fracture is seen in a throwing injury that involves severe muscle contraction. Surgical treatment is reserved for specific conditions. Nonoperative treatment of humeral shaft fractures revisited. However, good surgical outcomes can be achieved with proper patient selection. A custommade prefabricated brace was applied for the functional treatment of 21 isolated, closed, distal third humeral shaft fractures of 21 patients 17 male and 4 female. Treatment of the humeral shaft fractures minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace. This represents a growing public health concern in a climate of cost containment.
The anatomic location of the fracture, fracture pattern transverse, oblique, spiral, and amount and direction of angulation and displacement are criteria used to describe fractures. Methods and analysis we will conduct an rct to compare the effectiveness and costeffectiveness of surgical and conservative treatment of humeral shaft fractures. Carroll professor of surgery of the hand chief, orthopaedichand and trauma service director, trauma training center 2 overview. To ensure usersafety and faster downloads, we have uploaded this. Sutures are all underneath the skin and will dissolve on their own. Pdf treatment of the humeral shaft fractures minimally. Minimally invasive plating osteosynthesis for middistal. Humeral head fractures requiring surgical intervention are severe injuries, which might affect the return to sports and daily activities. Jan 10, 2017 keywords avulsion fractures casting and immobilization child abusenonaccidental trauma nat distal humerus physeal separation distal femur physeal fracture pediatric hip dislocation pediatric hip fracture humeral shaft fractures lateral condyle fracture medial epicondyle fracture pediatric ankle fractures pediatric forearm fracture pediatric clavicle fracture pediatric distal radius. Humeral shaft fractures account for about % of all fractures. Humeral shaft fractures are the second most common birth fracture. Pathological fractures through a humeral simple bone cyst are relatively common after minimal trauma in children over 7 years old. Humeral shaft fractures are defined as fractures in which the major fracture line occurs distal to the insertion of the pectoralis major and proximal to the supracondylar ridge.
There are both nonsurgical and surgical options for treatment of proximal humerus fractures. Humeral shaft fractures account for approximately 20% of fractures of the humerus in children. Humeral shaft fractures are challenging to manage as the treatment must be tailored to the individual patient and the specific fracture pattern. Flexible intramedullary nailing for treatment of proximal humeral and. Description 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. Diaphyseal fractures humerus, femur and tibia orthopaedic trauma for pas and nps ota annual meeting, october 17, 2018 objectives 1.
Humeral shaft fractures journal of shoulder and elbow surgery. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately. Classification this information is current as of january 22, 2009 reprints and. Humeral shaft fractures account for up to 5% of all fractures. Surgical treatment of three and fourpart proximal humeral. When operative treatment is required, plate osteosynthesis with open reduction. Radiographic templates of the stem and humeral head are used to preoperatively estimate the implant sizes. The aim of the current study was to comparethe outcome after operative 28 and nonoperative treatment of humeral shaft fractures, by comparing the time to radiological 29 union and the rates of delayed union and complications. In 1970, neer used the fourpart concept to develop a classification system for proximal humeral fractures. The main aim of treatment of the humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to preinjury level of.
Other causes include conditions such as cancer in the bone. Outcome of nonoperative vs operative treatment of humeral. Pdf nonoperative treatment of humeral shaft fractures revisited. There is a bimodal distribution of fractures with the majority occurring in children younger than 3 or older than 12. A relatively high incidence of radial nerve injury has been associated with surgical management of humeral shaft fractures. Principles of nonoperative treatment surgical indications pros and cons of plating and nailing. Treatment of the humeral shaft fractures is usually nonoperative. Multiple fractures in a newborn should suggest other musculoskeletal abnormalities such as osteogenesis imperfecta. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Handbook of fractures 5th edition pdf free download direct link. Study protocol open access treatment of the humeral.
Physiologically induced motion at the fracture site favors healing of the fracture. Based on these findings, we suggest that plating of humeral shaft fractures should be considered as the primary treatment for all. This study appears to establish plate fixation of open humeral shaft fractures as the gold standard of care. In this article, we are sharing with our audience the genuine pdf download of handbook of fractures 5th edition pdf using direct links which can be found at the end of this blog post. It is estimated that these fractures comprise 35% of all fractures in adults. Operative versus nonoperative treatment of humeral shaft fractures. Includes diaphyseal fractures of distal third of humerus.
This is the current gold standard method for conservative treatment of humeral shaft fractures. Indirect injuries are likely from a fall on the outstretched hand or from rotational injuries. A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. Although most humeral shaft fractures can be treated nonoperatively, many patients do benefit significantly from surgical treatment.
Jun 05, 20 acute management of humeral shaft fractures. Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, ao type 12a or 12b. Humeral shaft fractures account for % of all fractures and 20 % of the fractures 27 involving the humerus. This chapter focuses on the clinical presentation, diagnosis, treatment options, and longterm prognosis of humeral shaft fractures utilizing both retrospective and prospective data ranging from. Indications for nonoperative and operative treatment humeral shaft 1.
We demonstrate that surgical treatment of humeral shaft fractures in the united states has been increasing over time. Based on these findings, we suggest that plating of humeral shaft fractures should be. Parkinsons disease, proximal humeral fracture, conservative treatment 1. This is a basic article for medical students and other nonradiologists humeral shaft fractures are readily diagnosed and do not usually require internal fixation. Pdf download for operative versus nonoperative treatment of. Protected rom 6 weeks keep dressing in place, you may shower directly over clear plastic. These fractures are regarded as the domain of nonsurgical management. Shoulder fracture aurora clavicle fracture treatment denver. The shoulder is a ball and socket joint and you have fractured just below the ball part. Proximal humerus fracture you have sustained a fracture to your shoulder. Internal fixation of proximal humerus fractures with the polarus. In order to bring systems of treatment up to date and to better our results at beekmandowntown. Humeral shaft fractures represent 3% of all managed fractures and occur with an incidence of per 100,000 per year 1, 2.
The anterolateral approach to the humerus provides excellent exposure to the humeral shaft, especially to more proximal aspects. Codman wrote the fist description of proximal humeral fractures based on four parts. Management of radial nerve palsy associated with humeral shaft fracture. The ideal candidate for this treatment is a patient with an isolated fracture. Pdf operative treatment of humeral shaft fractures. Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. This, no doubt, proves that the ideal form of management still has to be found. The main hypothesis is that operative treatment will result in faster recovery. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. F ractures of the humeral shaft account for approximately 3% of all fractures.
Proximal humerus fracture east sussex healthcare nhs trust. Handbook of fractures 5th edition pdf free download. Epidemiology humeral shaft fractures account for 35% of all fractures 1,3. Fracture site mobility at 6 weeks after humeral shaft. These injuries occur in a bimodal age distribution affecting both young and. All books are the property of their respective owners. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in hsf cases are increasingly being adopted. Many humerus shaft fractures may be treated with a brace rather than surgery. Ice or cold flow systems encouraged for the first week at a minimum. The incidence is thought to be between 12 and 30 per 100,000 per year. This fracture is a hallmark of nonaccidental injury. The pdf of the article you requested follows this cover page. A great deal of controversy still persists as to the method of choice in treatment of shaft fractures of the humerus. Nonoperative treatment has been the perceived standard of care within the currently available literature for most patients with isolated injuries.
Humeral shaft fractures are readily diagnosed and usually, do not require internal fixation. The two modalities of internal fixation in fracture shaft of humerus. Fractures of the humeral shaft anatomy fracture classification nonoperativemanagement indications for surgical treatment. Functional treatment of the distal third humeral shaft fractures. Spiral fractures of the humerus in infants and toddlers are strongly linked with nonaccidental injury. Humeral shaft fracture summary radiology reference. Antegrade and retrograde nailing have similar treatment results, including healing rate and eventual functional recovery for middle humeral fractures. Treatment of bilateral proximal humeral fracture in.
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