eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Fracture, Humerus
Updated: Jul 16, 2008
Introduction
Background
Humerus fractures are commonly seen in the acute care setting and make up 5% of all fractures. In evaluating these injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important.
Eighty percent of humerus fractures are nondisplaced or minimally displaced, and therefore, can be managed nonoperatively. Associated injuries are common in patients with osteoporosis. Distal humeral fractures are associated with ipsilateral proximal forearm fractures. Rarely, vascular or nerve injuries are associated with humerus fractures.
This article discusses fractures based on location: proximal and diaphyseal (midshaft).
For more information, see Medscape’s Fracture Resource Center and Osteoporosis Resource Center.
Pathophysiology
Humerus fractures are caused by direct trauma to the arm or shoulder or by axial loading transmitted through the elbow. Attachments from pectoralis major, deltoid, and rotator cuff muscles influence the degree of displacement of proximal humerus fractures.
Frequency
United States
Humerus fractures represent 4-5% of all fractures. Humeral diaphyseal fractures account for 1.2% of all fractures.
Age
- Proximal humeral fractures are more common in elderly persons, with the average age of 64.5 years.
- Humeral diaphyseal fractures occur in a slightly younger population, with the average age being 54.8 years.
- Fracture patterns are similar across all ages, though older people are more prone to fracture because of osteoporosis.
Clinical
History
- History of a benign fall in which the elbow is either struck directly or axially loaded in a fall onto an outstretched hand.
- Motor vehicle and sport injuries account for most humeral injuries for younger males.
- Pathologic fractures of the humerus may occur with minimal trauma. Suspect these in patients with the following history:
- Cancer metastatic to bone
- Paget disease
- Bone cyst
- Pain without trauma
- Edema
- Decreased range of motion (ROM)
Physical
- Pain occurs with palpation or movement of shoulder or elbow.
- Ecchymosis and edema are usually present.
- Perform a careful neurovascular examination. Radial nerve injury following humerus shaft fractures is relatively common.
- Proximal
- Patients present with a painful shoulder and a very restricted range of motion.
- Obvious deformity is suggestive of glenohumeral dislocation; swelling and ecchymosis are the common examination findings.
- Nerve damage with a proximal humerus fracture is rare.
- Diaphyseal
- Patients present with a painful deformed arm that may be associated with a radial nerve palsy. Usually, the radial nerve palsy is reversible.
- Crepitus may be observed.
- Shortening of the arm suggests displacement.
- Assessment of the radial nerve
- The radial nerve’s primary motor function is to innervate the dorsal extrinsic muscles in the forearm. Motor testing should include extension of the wrist and metacarpophalangeal (MCP) joints as well as abduction and extension of the thumb. Proximal injury of the radial nerve causes wrist drop.
- On examination, the fingers are in flexion at the MCP joints and the thumb is adducted.
- Rarely, the median or ulnar nerves are affected.
- With all humerus fractures, ensure strong radial and ulnar pulses.
Causes
- The most common cause of proximal humeral fractures is a fall from standing, followed by motor vehicle accident and a fall involving stairs. Additional mechanisms include violent muscle contractions from seizure activity, electrical shock, and athletic-related trauma. Proximal humeral fractures are most often closed.
- Humeral diaphyseal fractures causes include a fall from standing, motor vehicle accident, a fall from height, and pathological.
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References
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Further Reading
Keywords
humerus fracture, fractured humerus, broken arm, broken shoulder, shoulder fracture, arm fracture, forearm fracture
