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Midshaft humeral fractures in children

Author
Leticia Manning Ryan, MD, MPH, FAAP
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

Fractures of the humeral shaft are uncommon, representing less than 10 percent of all fractures in children [1]. 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".)

PERTINENT ANATOMY

A thick periosteal sleeve is present along the humeral shaft that limits fracture displacement and promotes healing after fracture [2]. (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 [3]. A complete, transverse midshaft fracture at the medial third of the humerus is the typical fracture type and site (figure 1) [4].

                          

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 23 00:00:00 GMT+00:00 2015.
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References
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