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
Brachial plexus injury
Ipsilateral forearm fracture (" floating elbow")
Ipsilateral shoulder or elbow fracture
Bilateral humeral fractures
Lower-extremity fracture
Burns
Gunshot injury

Classification

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.

Workup

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Media Gallery

Diaphyseal humerus fracture.

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Author

Matthew Lawless, MD Assistant Professor of Orthopedic Surgery, Wright State University School of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, Miami Valley Hospital and Dayton Veterans Affairs Medical Center

Matthew Lawless, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Garrhett Glenn Via, MD Resident Physician in Orthopedic Surgery, Department of Orthopedic Surgery, Wright State University, Boonshoft School of Medicine

Disclosure: Nothing to disclose.

David A Brueggeman, MD Research Fellow, Department of Orthopedic Surgery, Wright State University, Boonshoft School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

Fady Y Hijji, MD Resident Physician, Department of Orthopaedic Surgery and Sports Medicine, Wright State University, Boonshoft School of Medicine

Disclosure: Nothing to disclose.

Midshaft Humerus Fractures Clinical Presentation

History and Physical Examination

Classification

References

Tables

Contributor Information and Disclosures

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