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)
- 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) .
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- 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