Midshaft humeral fractures in children
- Leticia Manning Ryan, MD, MPH, FAAP
Leticia Manning Ryan, MD, MPH, FAAP
- Assistant Professor of Pediatrics
- Division of Emergency Medicine
- Johns Hopkins Children's Center
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children . One of the most important features of humeral fractures in children is their ability to remodel and heal with minimal to no deformity despite displacement and angulation. The majority of these fractures can be treated by immobilization alone.
This review addresses midshaft fractures of the humerus in children. Fractures of the proximal and distal humerus, including supracondylar fractures, are presented separately. (See "Evaluation and management of supracondylar fractures in children" and "Epicondylar and transphyseal elbow fractures in children" and "Evaluation and management of condylar elbow fractures in children" and "Proximal humeral fractures in children".)
A thick periosteal sleeve is present along the humeral shaft that limits fracture displacement and promotes healing after fracture . (See "General principles of fracture management: Fracture patterns and description in children", section on 'Fracture patterns'.)
Following a displaced midshaft humeral fracture, the radial nerve is at potential risk for injury. Although nerve injuries may rarely be associated with long-term sequelae, the majority are neurapraxias, such as temporary loss of nerve function (especially motor function) without anatomical nerve disruption.
MECHANISM OF INJURY
Neonates — The humerus is second only to the clavicle as the most commonly fractured bone associated with birth trauma. Neonatal humeral fractures result from rotation or hyperextension of the upper extremity during passage through the birth canal . A complete, transverse midshaft fracture at the medial third of the humerus is the typical fracture type and site (figure 1) .
- Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 1993; 7:15.
- Bachman D, Santora S. Orthopedic trauma. In: Textbook of Pediatric Emergency Medicine, Fleisher GR, Ludwig S, et al. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.1537.
- Shrader MW. Proximal humerus and humeral shaft fractures in children. Hand Clin 2007; 23:431.
- Caviglia H, Garrido CP, Palazzi FF, Meana NV. Pediatric fractures of the humerus. Clin Orthop Relat Res 2005; :49.
- Carson S, Woolridge DP, Colletti J, Kilgore K. Pediatric upper extremity injuries. Pediatr Clin North Am 2006; 53:41.
- Shaw BA, Murphy KM, Shaw A, et al. Humerus shaft fractures in young children: accident or abuse? J Pediatr Orthop 1997; 17:293.
- Benjamin, HJ, Hang, BT. Common acute upper extremity injuries in sports. Clin Pediatr Emerg Med 2007; 8:15.
- Landin LA. Epidemiology of children's fractures. J Pediatr Orthop B 1997; 6:79.
- Sarmiento A, Horowitch A, Aboulafia A, Vangsness CT Jr. Functional bracing for comminuted extra-articular fractures of the distal third of the humerus. J Bone Joint Surg Br 1990; 72:283.
- Huber RI, Keller HW, Huber PM, Rehm KE. Flexible intramedullary nailing as fracture treatment in children. J Pediatr Orthop 1996; 16:602.
- Asche G. [Use of external fixation in pediatric fractures]. Zentralbl Chir 1986; 111:391.
- Sarwark J, King E, Luhmann S. Proximal humerus, scapula and clavicle. In: Rockwood and Wilkins' Fractures in Children, 6th ed, Beaty JH, Kasser JR. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.703.
- Shah JJ, Bhatti NA. Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases. Clin Orthop Relat Res 1983; :171.
- Lewallen RP, Peterson HA. Nonunion of long bone fractures in children: a review of 30 cases. J Pediatr Orthop 1985; 5:135.
- PERTINENT ANATOMY
- MECHANISM OF INJURY
- Children and adolescents
- Pathologic fracture
- Child abuse
- PHYSICAL FINDINGS
- Midshaft humeral fractures
- Neonatal fracture
- Associated findings
- RADIOGRAPHIC FINDINGS
- INITIAL TREATMENT
- Orthopedic consultation
- Child protection
- DEFINITIVE CARE
- Children and adolescents
- - Immobilization alone
- - Closed reduction
- - Surgical repair
- FOLLOW-UP CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Physical findings
- Definitive care