HUMERAL SHAFT FRACTURE


Diagnosis

Pathophysiology

 

Treatment

Complication

 

  Initial Treatment
Splint type & position Coaptation splint with collar and cuff sling if little traction is needed or if bracing or a hanging arm cast when traction is needed
Coaptation splint and standard sling for transverse fractures
Initial follow-up visit 1 to 2 weeks
1 to 2 days if cast is applied acutely
Pt instructions Initiate shoulder, hand, and finger ROM as soon as tolerated
If cast is applied acutely, carefully discuss symptoms of compartment syndrome
If hanging arm is cast applied, patient must not support elbow and must sleep upright
  Follow-up Care
Cast or Splint type & position Functional brace or hanging arm cast
Length of immobilization 10 to 12 weeks (continue until callus is present and the fracture site is non-tender and stable to manual stress)
Healing time 10 to 12 weeks
If not healed by 12 weeks, refer for surgical treatment for nonunion
Follow-up visit interval Weekly for 4 to 6 weeks; then every 2 weeks
Repeat radiography interval Weekly for 4 to 6 weeks; then every 2 weeks
Pt instruction Continued shoulder, hand, and finger ROM is emphasized
Directed elbow ROM if brace is used
When cast or brace is removed, increased ROM and strengthening exercises with special emphasis on the elbow
Indications for Ortho consult Neurovascular injury or open fracture
Transverse fractures
Provider unfamiliar with use of hanging arm cast and functional bracing
Suspected nonunion
Miscellaneous: pathologic fracture, associated elbow injury, multiple injuries, adequate closed reduction


Humeral fractures anterior view. The actions of the muscles inserting on the humeral shaft determine fracture angulation and displacement.
A.
Angulation of fragments with fracture line distal to rotator cuff insertion.
B.
Angulation of fragments with fracture line distal to pectoralis major insertion.
C.
Angulation of fragments with fracture line distal to deltoid insertion