MANUAL MINORS
A humeral shaft fracture affects the middle portion of the arm bone and may result from direct trauma (such as blows or traffic accidents) or indirect trauma (falls onto an outstretched arm). These fractures represent 3-5% of all fractures and can be associated with neurovascular injuries, particularly to the radial nerve, leading to difficulty extending the wrist and fingers (wrist drop).
Diagnosis
Diagnosis is based on a history of trauma, with symptoms such as intense pain, visible deformity in the arm, and abnormal mobility or crepitus at the fracture site. Numbness or weakness in the hand may be present if the radial nerve is compromised. Anteroposterior and lateral X-rays of the humerus are essential to confirm the fracture, its location, and the degree of displacement. A thorough neurovascular assessment of the arm is crucial.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Supracondylar humeral fracture | Fracture in the distal humerus, common in children, with visible deformity |
Brachial plexus injury | Pain, weakness, and numbness in the arm, without visible fracture |
Elbow dislocation | Deformity at the elbow, with inability to move the joint |
Surgical neck fracture of the humerus | Affects the proximal humerus, not the shaft, with deformity closer to the shoulder |
Bone contusion | Pain after trauma without visible fracture on X-rays |
Emergency Management
In emergencies, the affected arm should be immobilised with a splint or sling to stabilise the fracture and relieve pain. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain control.
A detailed neurovascular assessment is crucial, as the radial nerve is particularly vulnerable in this type of fracture. If there are signs of neurovascular compromise or open fractures, urgent surgical intervention is required.
Definitive Treatment
Definitive treatment depends on the type of fracture and whether it is displaced. Non-displaced fractures can be managed conservatively with immobilisation using a splint or functional cast for 8 to 12 weeks, followed by physiotherapy to restore range of motion and strength.
Displaced, unstable fractures or those with radial nerve injury may require open reduction and internal fixation (ORIF) with plates and screws or intramedullary nails. Recovery includes early rehabilitation to prevent joint stiffness and muscle atrophy, as well as monitoring nerve function if the radial nerve was affected.
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