Humerus Fracture Treatment & Management

Updated: Nov 07, 2019
  • Author: Adarsh K Srivastava, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

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 an orthopedist because of the risk of avascular necrosis. [26]

Humerus shaft (diaphyseal) fracture

Humerus shaft fractures 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 appropriate 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.” [27]

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Medical Care

Proximal humerus fracture

Displaced 3- or 4-part fractures frequently require surgical fixation. Open reduction and internal fixation is common in young patients. Humeral arthroplasty in older patients is common.

The most commonly performed surgical procedures include internal fixation with locking plates or humeral nails or replacement of the humeral head with a hemiarthroplasty or a total reverse prosthesis. [11]  However, randomized trials and non-randomized trials have questioned the benefits of these procedures in the elderly, even for displaced fractures. [9]

A study of surgery with locking plate of displaced 2-part proximal humerus fractures compared with non-operative treatment found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years or older. [10]

For nonsurgical fractures, continue sling for comfort and institute early range-of-motion exercises. Schedule initial follow-up visit within 1 week.

Humerus shaft fracture

Most humerus shaft fractures are treated nonoperatively, with an expected union rate of 90-100%, though surgical fixation, by either intramedullary nailing or plating, is necessary if the fracture is segmental or the vasculature is compromised.

Use coaptation splints until immediate postfracture pain has subsided, usually within 3-7 days. Then, place the patient in a functional brace. An orthopedic surgeon best addresses decisions regarding alignment, rotation, and progression to union.

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