Midshaft Humerus Fractures Clinical Presentation

Updated: Nov 08, 2022
  • Author: Matthew Lawless, MD; Chief Editor: Harris Gellman, MD  more...
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History and Physical Examination

Patients with humeral shaft fractures present with arm pain, deformity, and swelling. The arm is shortened, with motion and crepitus on manipulation. A careful neurovascular evaluation of the limb must be documented. Given that the incidence of radial nerve injuries with humeral shaft fractures is approximately 16%, careful evaluation of radial nerve sensation and motor function is indicated. [14]  A thorough physical examination should also include documentation of radial and ulnar pulses and skin integrity. [15]  If indicated, Doppler pulse and compartment pressures should be checked. [16, 17]

When evaluating polytrauma patients with humeral shaft fractures, clinicians should have a hightened suspicion for associated injuries. Injuries that may be seen in association with humeral shaft fractures include the following [18]

  • Open wound
  • Vascular injury
  • Ipsilateral forearm fracture (" floating elbow")
  • Ipsilateral shoulder or elbow fracture
  • Bilateral humeral fractures
  • Lower-extremity fracture
  • Burns
  • Gunshot injury


The Orthopaedic Trauma Association (OTA) and the Arbeitsgemeinschaft für Osteosynthesefragen (AO) developed a system of classification applicable to humeral shaft fracture. This system was first published in 1996 and was subsequently revised in 2007 and 2018. [19] In the current classification, humeral shaft fractures would first be labeled by the number of the bone or bone segment involved (12 in the case of the humeral diaphysis) and then be divided into the following three main types:

  • Type A - Simple fractures
  • Type B - Wedge fractures
  • Type C - Multifragmentary fractures

Each of these main type is divided into groups.

For type A (simple) fractures, the groups are determined by the angle of the fracture and consist of spiral fractures (A1), oblique (≥30º) fractures (A2), and transverse (< 30º) fractures (A3). The location of the fracture (proximal third, middle third, or distal third) is specified. 

Type B (wedge) fractures are divided into intact wedge fractures (B2) and fragmentary wedge fractures (B3). The location of the fracture (proximal third, middle third, or distal third) is specified.

Type C (multifragmentary) fractures are divided into intact segmental fractures (C2) and fragmentary segmental fractures (C3). Type C3 fractures are also subdivided on the basis of location (proximal diaphyseal–metaphyseal, pure diaphyseal, or distal diaphyseal–metaphyseal).

More detailed descriptions of these fractures may be achieved by using one or more "universal modifiers," which may be appended to the fracture code. Further information on the current AO/OTA classification is available on the AOTrauma Web site.