Midshaft humeral fractures in adults
- Rebecca Bassett, MD
Rebecca Bassett, MD
- Adjunct Clinical Assistant Professor
- University of North Carolina School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Fractures of the humerus can occur proximally, at the shaft, or distally. The majority of both proximal and midshaft humerus fractures are nondisplaced and can be treated conservatively (nonsurgically).
Nonstress fractures of the midshaft (diaphysis) of the humerus will be reviewed here. Stress fractures of the humeral shaft and proximal humeral fractures are discussed separately. (See "Stress fractures of the humeral shaft" and "Proximal humeral fractures in adults".)
The humerus is the largest bone in the upper extremity. The proximal humerus articulates with the glenoid of the scapula to form the shoulder joint (figure 1). The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments such as those between the coracoid process of the scapula and the acromion, serve to both stabilize the glenohumeral articulation and provide for a wide range of motion of the shoulder joint. The distal humerus articulates with the radius and ulna at the elbow.
The greater tuberosity, located lateral to the humeral head and on the superior aspect of the humerus, provides the attachment for three of the rotator cuff muscles: supraspinatus, infraspinatus and teres minor (figure 2). The lesser tuberosity of the humerus is located on the anterior surface of the humerus and provides the attachment for the subscapularis muscle. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft.
The humeral shaft supplies the attachment for a number of powerful muscles. The pectoralis major muscle inserts on the proximal shaft while the deltoid muscle attaches to the midshaft. The biceps brachii and triceps muscle groups attach further distally.
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- CLINICAL ANATOMY
- EPIDEMIOLOGY AND RISK FACTORS
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- Fracture patterns
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- Transverse fractures
- Spiral, oblique, and comminuted fractures
- - Sugar tong splint with collar and cuff sling
- - Hanging cast
- FOLLOW-UP CARE
- Transverse humerus shaft fractures
- - Functional bracing
- - Rehabilitation
- Results with functional bracing
- Displaced oblique or spiral humerus shaft fractures
- - Rehabilitation following use of hanging cast
- Radial nerve injury
- RECOMMENDATIONS FOR RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS