Humeral shaft fractures: Clinical picture, diagnosis, treatment.

Introduction

Humeral shaft fractures are common injuries, affecting 1% to 3-5% of all. Causes include falls, traffic accidents, and sports injuries. Risk factors include age, osteoporosis, and previous fractures. Treatment primarily involves nonsurgical methods like splints, casts, or functional braces, but nonunion is a common complication. Surgery is now widely used due to faster recovery and socio-economic benefits, but is associated with risks like infection and iatrogenic radial nerve palsy. This thesis aims to analyze clinical data and provide technical insights for managing patients with humeral shaft fractures.

The humeral shaft, located in the upper arm, is the main part of the humerus bone and serves to stabilize and support the arm. It is encircled by tendons and muscles that allow the arm to move and function. The bone has significant features and landmarks, such as the deltoid muscle, the deep artery of the arm, the nutritional foramen, and the medullary cavity.

Epidemiology of humeral shaft fractures:

3-5% of all fractures are humeral shaft fractures, with a bimodal distribution observed. The most common cause of injury is simple falls (41%-73%), followed by sports injuries (7%-8%), falls from heights (4%-14%), and traffic accidents (5%-8%). The mid shaft is involved in 43%-69% of fractures, with 16% being oblique, 17% spiral, and 4% comminuted or segmental.

Mechanism of trauma:

Humeral shaft fractures are most frequently caused by direct trauma from blunt or penetrating injuries, such as falls, car crashes, or motorcycle accidents. Elderly people may also experience it after falling on their outstretched arm, in which case the humerus sustains more damage than the wrist.

Clinical picture:

Physical examination reveals bone crepitation, pathological movements of the fragments, dezaxation with angulation and shortening, and loss of bone integrity. Radial nerve damage is the most significant clinical finding related to midshaft humerus fractures, accounting for 16% of radial nerve injuries.

Investigations:

A radiography can be done to determine the fracture.A thorough assessment of radial nerve sensation and motor function is recommended, including radial and ulnar pulses, skin integrity, partition pressures, and the Doppler pulse.

Complications:

Complications following a humeral shaft fracture include nonunion, angulation, restricted range of movement, infection, and damage to nerves.

Treatment methods:

Nonoperative management is the primary treatment for over 90% of humeral shaft fractures, with open fractures, polytrauma patients, ipsilateral humeral shaft and forearm fractures, and situations where the patient is unable to tolerate or maintain alignment in a functional brace being the only conditions that warrant surgical intervention. Surgery may be necessary in cases of brachial plexus or spinal cord injuries, and displaced intra-articular fracture extension linked to humeral shaft fractures.

Surgical outcomes have improved due to advancements in internal fixation modalities. Plate fixation is still the gold standard for fixing humeral shaft fractures, with early surgical interventions having a substantially higher union rate. Conservative management was linked to higher rates of nonunion and delayed union than surgery.

Nonsurgical management is effective in healing more than 90% of humeral shaft fractures, and a functional brace is usually placed after a coaptation splint or hanging arm cast has been applied. Techniques of surgical management include open reduction and internal fixation (ORIF), intramedullary nail fixation, and external fixation. ORIF enables faster secondary healing initiation and improved alignment of simple fractures, while the anterolateral approach exposes the radial nerve without causing as much soft tissue dissection.

Postoperative complications associated with nonoperative treatment include progressive fracture displacement and skin irritation to cast and splint materials, hardware failure, infection, non-healing of the surgical site, and protruding hardware. Nonunion and palsy of the radial nerve are not necessarily caused by treatment, but they can occur when the bone does not heal due to bone-healing processes not working or the body is not able to tolerate or maintain alignment in a functional brace.

Materials and methods:

A study was conducted on 104 patients at the Institute of Emergency Medicine’s Department of Traumatology, focusing on humeral shaft fractures. The study found that the incidence of humeral shaft fractures increases in the late middle age group, with the least number of cases after the age of 70. The most common cause of humeral shaft fractures was habitual trauma, sports, assaults, at streets, and accidents.

The majority of patients experienced simple spiral and bending wedge fractures, with a few exceptions. The majority of patients experienced closed fractures, with a few exceptions. The majority of patients had left side fractures, with a significant percentage experiencing isolated trauma. The most significant complication observed was radial nerve injury, with 7.7% of patients experiencing nerve injury.

The majority of patients received surgical treatment, with 76.9% of patients receiving it. Patients who had open reduction with osteosynthesis recovered more quickly and were more satisfied with the outcome. Only 23.1% of patients received conservative care, and the majority of those cases were relatively minor.

Osteosynthesis with plates and screws was the most common type of treatment, with 30.8% of cases treated with a centromedullary rod. Post-operative complications were not observed, but few cases of post-traumatic radial neuropathy were present.

Results and discussion:

Humeral shaft fractures are more common in individuals over 50 years old, with 46.2% of cases being elderly. Surgical treatments are limited due to comorbidities and comorbidities. Injuries are mainly caused by home trauma. Most patients are discharged after a week, reducing mental and emotional instability. Over 50% of patients receive surgical intervention, reducing complications and ensuring successful healing in complicated fractures. Conservative treatments have a higher rate of nonunion.

Conclusion:

Humeral shaft fractures affect 3-5% of all fractures, affecting the entire arm and impacting self-care. Most patients are older (46.2%), with a slight female to male ratio. Quick recovery can improve quality of life. Despite conservative management being the gold standard, 76.9% of patients received surgical treatment with ORIF, demonstrating successful treatment with shorter hospital stays and no postoperative complications.