Page created on October 25, 2021. Last updated on October 27, 2021 at 12:39

Summary

• Proximal humerus fracture is the most common fracture site of the humerus. It’s more common in elderly women usually due to fall on outstretched arm. It’s classified according to the NEER classification. Axillary nerve injury may occur. Treatment is mostly conservative with a sling.
• Midshaft humeral fractures may occur in young or elderly, mostly in young. Radial nerve injury may occur. Treatment is mostly conservative with a hanging cast/sling.

Proximal humeral fracture

Definition and epidemiology

Proximal humerus fracture is the most common form of humeral fracture. It’s more common in elderly women, due to osteoporosis.

Etiology

Fall onto outstretched arm or high energy trauma.

Classification

Proximal humeral fractures are classified according to the NEER classification, according to which part of the proximal humerus is involved and the number of displaced segments.

Clinical features

Patient holds the arm close to the chest with the healthy arm. Pain and crepitus may be detected on palpation. There may be decreased lateral deltoid sensation and deltoid function due to axillary nerve injury.

Diagnosis and evaluation

X-ray is usually sufficient, but CT may be necessary for dislocation or multifragmented fractures. MRI is indicated in suspected rotator cuff injury.

Treatment

Conservative in case of minimally displaced fractures. It involves a sling and physical therapy.

Operative in case of open, displaced, multifragmented, or anatomical neck fractures, or if there is neurovascular injury. It involves screws, K-wires, tension band, plate, hemiarthroplasty, or delta prosthesis.

Middle shaft humeral fracture

Definition and epidemiology

Middle shaft humeral fractures are less common than proximal fractures and may occur in elderly or young. Radial nerve injury may occur, especially if the distal third is involved.

Etiology

High energy trauma (young, most common) or fall onto outstretched arm (elderly).

Clinical features

Pain, swelling, deformity. Possible radial nerve injury.

Diagnosis and evaluation

X-ray is sufficient. Traction x-ray may be indicated in case of displacement or comminution.

Treatment

Conservative in most cases, with reduction followed by a hanging cast/splint. Surgery may be necessary in case of neurovascular injury, failed reduction, nonunion, or open, segmental, or transverse fractures.