Displaced Humeral Shaft Fracture before and after repair

 

 

Humeral Shaft fractures

 

Fractures of the humeral shaft are painful and can be debilitating injuries.  Most, however, heal uneventfully without long term problems or limitations. The most common treatment of these injuries involves the use of cast braces and the majority of humeral shaft fractures do not require surgery. Surgical repair is limited to fractures which have a high propensity for late problems. This includes open fractures (fractures in which the bone punctures the skin), concomitant radial nerve injury, patients with multiple fractures (especially lower extremity fractures) and obesity. There is a large nerve called the radial nerve that runs along the posterior aspect of the humerus and actually sits on bone for several inches througout its course. This nerve can be injured in this area in cases of humeral shaft fracture. Patients with radial nerve injuries have a "wrist drop" which is an inability to extend the wrist or fingers in the involved had.  I check this nerve carefully when evaluating patients with humerus fractures.

 

      

 

Patient with wrist drop from a radial nerve injury        Course of the radial nerve in the arm

 

 

In patients whom I feel surgery is warranted, fixation options include nails and plates; however, I typically use plate fixation for humeral shaft fractures as it has much better biomechanical fixation characteristics and allows me to isolate and protect the radial nerve.   This nerve is commonly at risk of injury during surgery. Unfortunately, the relatively open approach used for the placement of the plate results in larger incisions than those when placing a nail.  The iatrogenic (caused by the surgeon) complication rate is significantly higher when using nails ( nerve injury). Because this complication often results in permanent impairment of the hand, I do not put nails in except in a few rare instances.

The two links below take you to the plating systems that I use to repair these fractures:

 

Synthes Plating System

 

Stryker Plating System

 

Complication rates with humeral plating are fairly low, but the incisions required to repair these fractures are long and not particularly cosmetic. I am fairly conservative in the selection of patients in whom I offer surgical repair. In cases where the bone is well reduced (lined up well) the long term functional outcome  is the same with or without surgery, so if I think I can maintain the postion of the bones in a cast, this my preferred treatment. When treating humeral fractures without surgery, the first few weeks after sustaining a humerus fracture are very difficult for most patients as its hard to find a comfortable position.  Most patients report "feeling" a clicking sensation at the fracture site.  This subsides after a few weeks and most patients are relatively comfortable after about 2-3 weeks.  I transition patients to a fracture brace at about 3-4 weeks out and encourage patients to begin moving their elbow.  This muscle function helps to keep the bone lined up and stimulates healing of the fracture.  I discontinue the fracture brace after about 8 weeks although I don't recommend patients return to contact sports for at least 6 months after the injury. I use two orthotics manufacturers close to the downtown area.  They are responsive and do really nice work in helping to customize fracture braces. You can click on either link below to view their website and find the nearest location to you.

 

Dynamics Orthotics

 

Hanger Prosthetics

 

    

 

Examples of humeral fracture braces

 

Humerus Fracture in a coaptation brace

 

 

 I have also included a website that allows you to purchase the fracture brace directly from the manufacturer.  Although this may save you some money, if there is a problem with the fit of the brace, you are on your own. 

 

Off the Shelf Braces

 

If I dont think that I can maintain the alignment of the bone in a cast or the patient has a number of other fractures, especially in the lower extremities, I recommend surgical repair with plates and screws. After plating, recovery is surprisingly quick and most patients have return of function of their arm within 4-6 weeks. Therapy to regain range of motion in the shoulder and elbow are critical to obtain a good outcome. The plates and screws implanted during surgery are usually permanent and do not require removal at a later date.

 

 

 Click here to see my post-operative arm fracture instruction sheet