Humerus Fracture 

  • Author: Adarsh K Srivastava, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Sep 19, 2011
 

Background

In evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important.

Eighty percent of proximal humerus fractures are nondisplaced or minimally displaced, and therefore, can be managed nonoperatively.[1, 2, 3] 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.

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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.

Humeral stress fractures occur with overhead throwing and occasionally with violent muscle contractions. These types of fractures are documented most commonly in baseball. As with other stress fractures, an increase in activity or stress on immature or unconditioned bone is the likely culprit.[4, 5, 6]

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Epidemiology

Frequency

United States

Humeral diaphyseal fractures account for 1.2% of all fractures.[7]

Proximal humerus fractures account for 5.7% of all fractures.[7]

Age

Proximal humeral fractures are more common in elderly persons, with the average age of 64.5 years.[8]

Proximal humeral fractures are the third most common fracture after hip fractures and distal radius fractures.[2, 9]

Humeral diaphyseal fractures occur in a slightly younger population, with the average age being 54.8 years.[8]

See the image below.

Diaphyseal humerus fracture. Diaphyseal humerus fracture.

Fracture patterns are similar across all ages, though older people are more prone to fracture because of osteoporosis.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Andrew A Aronson, MD, FACEP  Vice President, Physician Practices, Bravo Health Advanced Care Center; Consulting Staff, Department of Emergency Medicine, Taylor Hospital

Andrew A Aronson, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L 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.

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  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

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

References

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  2. Cheung EV, Sperling JW. Management of proximal humeral nonunions and malunions. Orthop Clin North Am. Oct 2008;39(4):475-82, vii. [Medline].

  3. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. Sep 1970;52(6):1077-89. [Medline].

  4. Brukner P. Stress fractures of the upper limb. Sports Med. Dec 1998;26(6):415-24. [Medline].

  5. Ogawa K, Yoshida A. Throwing fracture of the humeral shaft. An analysis of 90 patients. Am J Sports Med. Mar-Apr 1998;26(2):242-6. [Medline].

  6. Pehlivan O, Kiral A, Akmaz I, Solakoglu C, Arpacioglu O, Kaplan H. Humeral shaft fractures secondary to throwing. Orthopedics. Nov 2003;26(11):1139-41. [Medline].

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

  9. Baron AA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18:209S-13S.

  10. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. Dec 2005;87(12):1647-52. [Medline].

  11. Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and imaging of proximal humerus fractures. Orthop Clin North Am. Oct 2008;39(4):393-403, v. [Medline].

  12. Anglen JO, Archdeacon MT, Cannada LK, Herscovici D Jr. Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am. Jul 2008;90(7):1580-9. [Medline].

  13. 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].

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  15. 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.

  16. 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].

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

  18. 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].

  19. Rosen P. Emergency Medicine. 6th ed. Mosby-Year Book, Incorporated; 2006:647-69.

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

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

  22. 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.

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

 
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Diaphyseal humerus fracture.
Neer classification.
 
 
 
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