Humeral shaft fracture

Question 1

WHo do they most commonly occur in?

Answer 1

Bimodal distribution
Younger - high energy trauma
Elderly - low impact injuries

Question 2

What nerve is at risk of damage in this fracture?

Answer 2

Radial nerve

Question 3

What is the name of the groove the radial nerve travels in?

Answer 3

Spiral groove

Question 4

What risk factors are there?

Answer 4

Osteoporosis
Increasing age
Previous fractures

Question 5

What clinical features are associated?

Answer 5

Pain and deformity

If radial nerve involved: reduced sensation over dorsal 1st webspace and weakness in wrist extension

Question 6

What is a Holstein-Lewis fracture?

Answer 6

Fracture of distal third of humerus resulting in entrapment of radial nerve
Surgical management indicated

Question 7

What imaging is done?

Answer 7

AP and lateral plain film - elbow and shoulder should be visible

In severely comminuted cases, CT imaging may be requested for pre op planning

Question 8

How are they managed?

Answer 8

Majority conservatively in a functional humeral brace and gravity traction by means of collar and cuff sling
Imobilisation for 8-12 weeks