Slideshow
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Figure 1. Anterioposterior radiograph of the left humerus.
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Figure 2. Lateral view of the humerus.
A 33-year-old man presents to the emergency department with left arm pain after a motorcycle accident 2 hours earlier. He lost control of the bike and fell on his left arm. He has significant pain and can’t lift his arm away from his side (Figure 1 and 2). He has mild swelling, his skin is intact, and his neurovascular examination is normal.
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Humeral shaft fractures are generally treated nonoperatively as gravity helps assist fracture reduction for displaced fractures.1 Healing rates are as high as 90% with nonoperative treatment.
Criteria for nonoperative treatment include2:
- <20° of anterior angulation
- <30° of varus/valgus angulation
- <3 cm of shortening
Humeral bracing is indicated for nonoperative fractures to help stabilize the fracture. A Sarmiento brace wraps circumferentially around the humerus and allows mobilization of the shoulder and elbow joint. A coaptation or U-shaped splint should be placed proximal to the axilla and over the deltoid laterally. A sling takes away some of the gravitational pull on the arm that helps reduce the fracture and is not ideal for humeral shaft fractures.1,3
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopaedics for Physician Assistants.
References
1. Attum B, Obremskey W. Treatment of humeral shaft fractures. A critical analysis review. JBJS Rev. 2015;3(9):e5. doi:10.2106/JBJS.RVW.N.00119
2. Weatherford B. Humeral shaft fracture. OrthoBullets. Updated July 3, 2022. Accessed July 13, 2022. https://www.orthobullets.com/trauma/1016/humeral-shaft-fractures
3. Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg. 2015;24(2):210-214. doi:10.1016/j.jse.2014.05.009
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