eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Humerus

Author: Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Coauthor(s): Adarsh K Srivastava, MD, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Contributor Information and Disclosures

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.

More on Fracture, Humerus

Overview: Fracture, Humerus
Differential Diagnoses & Workup: Fracture, Humerus
Treatment & Medication: Fracture, Humerus
Follow-up: Fracture, Humerus
Multimedia: Fracture, Humerus
References

References

  1. Byrd RG, Byrd RP Jr, Roy TM. Axillary artery injuries after proximal fracture of the humerus. Am J Emerg Med. Mar 1998;16(2):154-6. [Medline].

  2. Keller A. The management of gunshot fractures of the humerus. Injury. Mar 1995;26(2):93-6. [Medline].

  3. McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. Aug 1994;10(3):479-94. [Medline].

  4. Minkowitz B, Busch MT. Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am. Oct 1994;25(4):581-94. [Medline].

  5. Niall DM, O'Mahony J, McElwain JP. Plating of humeral shaft fractures--has the pendulum swung back?. Injury. Jun 2004;35(6):580-6. [Medline].

  6. Rosen P. Emergency Medicine. 2nd ed. Mosby-Year Book, Incorporated; 1988:735-758.

  7. Szyszkowitz R, Seggl W, Schleifer P, et al. Proximal humeral fractures. Management techniques and expected results. Clin Orthop Relat Res. Jul 1993;13-25. [Medline].

  8. Tintinalli J, Ruiz E, Krome R. Emergency Medicine. 4th ed. McGraw Hill Text; 1996:1242-1244.

  9. Wilkins KE. Supracondylar fractures: what's new?. J Pediatr Orthop B. Apr 1997;6(2):110-6. [Medline].

  10. Mckee MD. Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. Vol 1. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:1117-1159.

  11. Warner JP, Costouros JG, Gerber C. Fractures of the proximal humerus. In: Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. Vol 1. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:1161-1205.

  12. Brown CC, McQueen MM, Tornetta III P. Orthopedic Surgery Essentials: Trauma. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:89-114.

Further Reading

Keywords

humerus fracture, fractured humerus, broken arm, broken shoulder, shoulder fracture, arm fracture, forearm fracture

Contributor Information and Disclosures

Author

Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Andrew A Aronson, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Adarsh K Srivastava, MD, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Adarsh K Srivastava, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michelle Ervin, MD, Chair, Department of Emergency Medicine, Howard University Hospital
Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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