Humerus Fracture Treatment & Management
- Author: Adarsh K Srivastava, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Immobilize the fracture.
Emergency Department Care
Minimize the patient's movement and provide adequate analgesia to make the patient comfortable in the acute care setting.
Proximal humerus fracture
Most minimally displaced proximal humeral fractures can be managed nonoperatively.
Greater tuberosity fractures may have associated rotator cuff tears. The true incidence of rotator cuff tears is unknown. They are more common in older patients, high-energy injuries, and where there is significant displacement.
Sling and swathe application is the primary treatment.
Fractures of the anatomical neck should be referred to orthopedist due to the risk of avascular necrosis.
Humerus shaft (diaphyseal) fracture
Humerus shaft fracture should be stabilized using a coaptation splint.
Wrap splinting material snugly from axilla to nape of neck, creating a stirrup around the elbow.
Fracture reduction is usually not necessary because reduction is difficult to maintain.
Because of the shoulder's ability to compensate, 30-40° of angulation is acceptable.
AAOS use criteria
The American Academy of Orthopaedic Surgeons (AAOS) has developed Appropriate Use Criteria (AUC) for the management of pediatric supracondylar fractures. Of the 3080 possible treatments and scenarios (ie, 220 patient scenarios x 14 treatments), 678 (22%) were rated as “Appropriate,” 431 (14%) were rated as “May Be Appropriate,” and 1971 (64%) were rated as “Rarely Appropriate.”
Most isolated proximal and diaphyseal humeral fractures can be managed by an orthopedist in an outpatient setting. Even patients with fractures that may eventually require surgery generally may be discharged with early follow-up care if fracture is otherwise uncomplicated.
Fractures that cannot be adequately reduced or when fracture reduction cannot be controlled with functional bracing because of patient obesity, head trauma, or soft tissue injuries, surgical stabilization is indicated.
Open fractures represent a surgical emergency; obtain an immediate orthopedic consult.
Penetrating trauma requires particular neurovascular scrutiny.
Glenohumeral dislocation in conjunction with a proximal humerus fracture requires orthopedic evaluation.
Floating elbow (an ipsilateral humerus and forearm fracture) requires operative repair.
Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008 Nov. 90(11):1407-13. [Medline].
Cheung EV, Sperling JW. Management of proximal humeral nonunions and malunions. Orthop Clin North Am. 2008 Oct. 39(4):475-82, vii. [Medline].
Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970 Sep. 52(6):1077-89. [Medline].
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. 2005 Dec. 87(12):1647-52. [Medline].
Brukner P. Stress fractures of the upper limb. Sports Med. 1998 Dec. 26(6):415-24. [Medline].
Ogawa K, Yoshida A. Throwing fracture of the humeral shaft. An analysis of 90 patients. Am J Sports Med. 1998 Mar-Apr. 26(2):242-6. [Medline].
Pehlivan O, Kiral A, Akmaz I, Solakoglu C, Arpacioglu O, Kaplan H. Humeral shaft fractures secondary to throwing. Orthopedics. 2003 Nov. 26(11):1139-41. [Medline].
Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006 Aug. 37(8):691-7. [Medline].
Brown CC, McQueen MM, Tornetta III P. Orthopedic Surgery Essentials: Trauma. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006. 89-114.
Grawe B, Le T, Lee T, Wyrick J. Open Reduction and Internal Fixation (ORIF) of Complex 3- and 4-Part Fractures of the Proximal Humerus: Does Age Really Matter?. Geriatr Orthop Surg Rehabil. 2012 Mar. 3(1):27-32. [Medline]. [Full Text].
Baron AA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996. 18:209S-13S.
Pedrazzoni M, Abbate B, Verzicco I, Pedrazzini A, Benatti M, Cervellin G. Humeral fractures due to low-energy trauma: an epidemiological survey in patients referred to a large emergency department in Northern Italy. Arch Osteoporos. 2015. 10:228. [Medline].
Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and imaging of proximal humerus fractures. Orthop Clin North Am. 2008 Oct. 39(4):393-403, v. [Medline].
Barco R, Barrientos I, Encinas C, Antuña SA. Minimally invasive poly-axial screw plating for three-part fractures of the proximal humerus. Injury. 2012 Dec. 43 Suppl 2:S7-S11. [Medline].
Urda A, González A, Colino A, Lópiz Y, García-Fernández C, Marco F. Management of displaced surgical neck fractures of the humerus: health related quality of life, functional and radiographic results. Injury. 2012 Dec. 43 Suppl 2:S12-9. [Medline].
Anglen JO, Archdeacon MT, Cannada LK, Herscovici D Jr. Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am. 2008 Jul. 90(7):1580-9. [Medline].
Claessen FM, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg. 2015 Sep 2. [Medline].
Byrd RG, Byrd RP Jr, Roy TM. Axillary artery injuries after proximal fracture of the humerus. Am J Emerg Med. 1998 Mar. 16(2):154-6. [Medline].
Keller A. The management of gunshot fractures of the humerus. Injury. 1995 Mar. 26(2):93-6. [Medline].
Mckee MD. Fractures of the shaft of the humerus. Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006. Vol 1: 1117-1159.
McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. 1994 Aug. 10(3):479-94. [Medline].
Minkowitz B, Busch MT. Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am. 1994 Oct. 25(4):581-94. [Medline].
Niall DM, O'Mahony J, McElwain JP. Plating of humeral shaft fractures--has the pendulum swung back?. Injury. 2004 Jun. 35(6):580-6. [Medline].
Rosen P. Emergency Medicine. 6th ed. Mosby-Year Book, Incorporated; 2006. 647-69.
Siddiqui YS, Khan AQ, Sherwani M. Pathological Fractures in Primary Non-Hodgkin's Lymphoma of the Bone: A Case Series with Review of the Literature. J Clin Diagn Res. 2013 Mar. 7(3):513-7. [Medline]. [Full Text].
Szyszkowitz R, Seggl W, Schleifer P, Cundy PJ. Proximal humeral fractures. Management techniques and expected results. Clin Orthop Relat Res. 1993 Jul. 13-25. [Medline].
Tintinalli J, Ruiz E, Krome R. Emergency Medicine. 4th ed. McGraw Hill Text; 1996. 1242-1244.
Warner JP, Costouros JG, Gerber C. Fractures of the proximal humerus. Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006. Vol 1: 1161-1205.
Wilkins KE. Supracondylar fractures: what's new?. J Pediatr Orthop B. 1997 Apr. 6(2):110-6. [Medline].