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Fractures of the body of the humerus: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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ICD-10 code
S42.3. Fracture of shaft [diaphysis] of humerus.
[ What causes a humeral shaft fracture?
The mechanism of injury can be direct and indirect. In the first case - a blow to the shoulder or the shoulder on a hard object, in the second - a fall on the wrist or elbow joint of the abducted arm, excessive rotation of it along the axis.
Symptoms of a fracture of the humeral shaft
The symptoms are identical to any fracture of a long tubular bone: pain, impaired function.
Anamnesis
The anamnesis indicates a corresponding injury.
Inspection and physical examination
Characteristic features include deformation and shortening of the limb, pathological mobility, crepitus, decreased sound conductivity of the bone, and a positive symptom of axial load.
Shoulder injuries may be accompanied by damage to the neurovascular bundle; the radial nerve is most often affected by fractures of the humeral shaft. Therefore, it is necessary to check the skin sensitivity and motor function in the innervation zone of the radial, ulnar and median nerves.
Laboratory and instrumental studies
To clarify the shape of the fracture, the presence of fragments, and the degree of displacement of the fragments, it is necessary to perform an X-ray of the shoulder in two projections.
In fractures of the humeral diaphysis, depending on the level of damage, three types of typical displacements of fragments are distinguished.
- The first type. The fracture line passes above the attachment of the pectoralis major muscle. Due to the contraction of the supraspinatus, infraspinatus and teres minor muscles attached to the greater tubercle, the central fragment takes the position of abduction outward and forward and is rotated outward. The peripheral fragment is brought inward by the force of the pectoralis major muscle, pulled up and, under the action of the biceps and triceps brachii muscles, is rotated inward (with the elbow joint extended) under the influence of the physiological position of the limb - pronation.
- Type 2. The fracture line passes below the attachment of the pectoralis major muscle, but above the deltoid (middle third of the shoulder). The central fragment is adducted and moderately rotated inward by the force of the pectoralis major muscle.
- The peripheral fragment is moderately abducted outward and pulled upward due to the contraction of the deltoid muscle and the entire muscular sheath of the shoulder.
- Type III. The fracture line passes below the attachment of the deltoid muscle, which exerts maximum influence on the central fragment, diverting it outward and forward. The peripheral fragment is pulled upward as a result of contraction of the muscular sheath of the shoulder.
Treatment of fracture of the body of the humerus
There are conservative and surgical treatment methods, each of which has its own indications.
Indications for hospitalization
Treatment of diaphyseal fractures of the humerus is carried out in a hospital setting.
Conservative treatment of humeral shaft fracture
In case of fractures without displacement of fragments, treatment consists of anesthetizing the fracture site with a 1% procaine solution and applying a plaster thoracobrachial bandage in a functionally advantageous position. From the 3rd day, UHF, exercise therapy for the fingers and wrist joint are prescribed. Subsequently, drug and physical therapy are carried out aimed at creating optimal conditions for regeneration. The duration of permanent immobilization is 6-8 weeks, intermittent - 2-3 weeks. After the immobilization is eliminated, X-ray control is carried out and complex restorative treatment is started. Work is allowed after 9-11 weeks.
In case of fractures with displacement of fragments, there are two methods of conservative treatment: one-stage repositioning and traction.
Closed single-stage manual reposition is performed in cases where the fracture line is located closer to the metaphysis, has a cross-section, and there is a guarantee that after matching the fragments, their secondary displacement will not occur. The manipulation is performed under local or general anesthesia, taking into account the displacement of the fragments and observing the basic laws of reposition. Matched fragments are fixed with a plaster thoracobrachial bandage, further tactics are no different from the treatment of patients with humeral fractures without displacement of fragments.
Traction is indicated for oblique and spiral fractures of the humerus, when the fragments are easy to align, but they are also easily displaced when the repositioning force is stopped. Traction can be skeletal, adhesive, and by the Caldwell-Ilyin method.
- In skeletal traction, the needle is passed through the olecranon perpendicular to its long axis and secured in a bracket. The limb is placed on an abduction splint. A cord is tied to the bracket, thrown over the splint block and fixed to a spring or rubber traction, creating a tension force of 3-4 kg. Skeletal traction is continued for 3-4 weeks (until the primary, soft callus forms), then a plaster thoracobrachial bandage is applied until the end of the consolidation period.
- Glue stretching is used when it is impossible to pass a knitting needle for some reason.
- Caldwell-Ilyin traction has the same indications as the two previous ones, but it is preferable for people with injuries or diseases of the chest, respiratory organs and blood circulation, since it does not involve the application of bulky abduction splints of plaster thoracobrachial bandages. The method should be included in the section on disaster medicine as an element of the treatment of multiple injuries. A circular plaster bandage is applied from the shoulder joint to the heads of the metacarpal bones with plastered wire rings in the area of the olecranon and the radial surface of the wrist. A cotton-gauze roller is placed in the axillary region to give the limb abduction by 30-40°. The method is based on constant traction.
Permanent immobilization for fractures of the humeral body with displacement of fragments lasts 8-10 weeks, removable - 4 weeks.
Working capacity is restored within 12-14 weeks.
Surgical treatment of fracture of the humeral body
Surgical treatment of patients with fractures of the humeral shaft is indicated in cases of damage to the neurovascular bundle, interposition of soft tissues, open, comminuted or segmental fractures with uncontrollable fragments. The latter include bone fragments that lack muscle attachment points.
Surgical treatment consists of open reposition and fixation of fragments in one of the following ways: intraosseous, extraosseous, combined, or extrafocal.
The soft tissues are cut, exposing the fracture site. The nail is driven into the central fragment until it emerges under the skin above the greater tubercle. The skin above the superior end is cut, and the nail is driven completely into the central fragment, leaving 0.5-1 cm. The fragments are aligned and the nail is driven retrogradely, from top to bottom, into the peripheral fragment.
The pin can be introduced into the humerus from other points as well: from additional incisions in the area of the greater tubercle or from the olecranon fossa above the olecranon process, where the bone is drilled obliquely and parallel to the longitudinal axis to communicate with the medullary canal. A metal nail is driven in through these holes after repositioning, which, passing through the medullary canals of both fragments, tightly fastens them.
In recent years, closed intramedullary osteosynthesis of the shoulder in static or dynamic versions has been used in trauma hospitals with the appropriate equipment. The rod can be inserted into the bone from the proximal or distal end.
If starting from the proximal end, make a 2-3 cm incision, exposing the large tubercle, and open the medullary canal a little more medially with a cannulated awl along a previously inserted Kirschner wire to a depth of 6 cm. After preparing the canal (measuring, etc.), fix the rod in the guide, install the target guide and insert it into the medullary canal using a pusher. Place distal and then proximal locking screws (or a screw). Disconnect the rod from the guide. Install a compression or blind screw. Immobilization is not required.
The bone fixation of fragments is carried out using cerclages and all kinds of plates. Cerclages are acceptable for oblique and spiral fractures with the fracture line directed at an acute angle and a large area of contact between the fragments. However, this method is not widely used due to the creation of circular "strangles" and disruption of bone trophism. Plates are best used for transverse fractures in places with a flat surface, allowing for close contact between the fixator and the bone.
The technique of fixing the fragments with a plate is simple: the fragments are aligned and secured with bone holders. Covering the fracture line, a plate is placed on the bone, through its holes, channels are drilled into the bone, and it is necessary to drill through both cortical layers. The plate is screwed to the bone, the bone holders are removed.
Osteosynthesis with plates did not always lead to the desired results, so in the early 1950s, a search for their improvement began. In subsequent years, self-compressing plates of various shapes were developed, which can fix fragments of any bone area. Minimally invasive plates appeared, installed from minimal (several centimeters long) incisions, fastened with screws from point punctures along special guides. Some plates are connected with dynamic screws, have additional angular stability and have completely displaced old plates, beams, cerclages, etc. from the everyday life of traumatologists.
Osteosynthesis with modern plates does not require additional external immobilization.
And yet, in case of fractures with an oblique or spiral long fracture line, multi-fragmentary and segmental fractures of the humeral shaft, when the surgeon is forced to use more than 6 screws to fix the plate, the risk of surgical trauma and complications increases. Therefore, we should agree with surgeons who believe that plates on the shoulder should be used in cases where it is impossible to use intramedullary osteosynthesis with external fixation devices. Spoke and rod external fixation devices remain among the advanced methods of treating shoulder fractures.