Humerus Fracture Treatment & Management

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

Prehospital Care

  • Immobilize the fracture.
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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.
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Consultations

  • 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.[12]
  • 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.
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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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Diaphyseal humerus fracture.
Neer classification.
 
 
 
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