| Introduction |
.jpg) Mechanism
- typically associated with trauma
- most common long bone injury associated with child abuse
- consider a pathologic process if fracture is a result of a low energy mechanism
- Associated injuries
- as with adults, a radial nerve palsy can be seen in middle and distal third fractures
- associated with up to 5% of humeral shaft fractures
- Prognosis
- excellent
- associated with enormous remodeling potential and rarely requires surgical intervention
- up to 30° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
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| Presentation |
- Symptoms
- pain, deformity, history of traumatic event
- Exam
- tenderness to palpation, deformity
- weakness or absence of wrist and digit extension if radial nerve palsy is present
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| Imaging |
- Radiographs
- humerus AP & lateral
- typically allow complete evaluation of fracture pattern and displacement
- orthogonal views of shoulder and elbow
- required to rule out associated injuries
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| Treatment |
- Nonoperative
- immobilization
- indications
- uncomplicated diaphyseal fracture without intra-articular involvement in a child of any age
- utilized for almost all pediatric humeral shaft fractures
- techniques
- sling and swathe or cuff and collar in children < 3 years
- Sarmiento functional brace in children > 3 years
- ROM exercises can be initiated in 2-3 weeks once pain is controlled
- Operative
- open reduction internal fixation
- indications
- open fractures
- neurovascular compromise after reduction
- multiply injured patient
- floating elbow
- associated shoulder injury
- techniques
- flexible intramedullary nail fixation
- anterior, anterolateral or posterior approach with plate fixation
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| Complications |
- Radial nerve palsy
- typically due to a neuropraxia
- spontaneous resolution is expected
- exploration is rarely needed
- if function has not returned in 3-4 m then EMGs are performed and exploration considered
- Malunion
- rarely produces funtional deficits due to the wide range of motion at the shoulder
- up to 30° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
- Limb length discrepancy
- commonly occurs but rarely causes functional deficits
- Compartment syndrome
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