Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jul 31 2023

Humeral Shaft Fracture - Pediatric

Images
https://upload.orthobullets.com/topic/4005/images/pediatric humerus fracture (2).jpg
https://upload.orthobullets.com/topic/4005/images/figure-3_remodelling_humeral-shaft.jpg
https://upload.orthobullets.com/topic/4005/images/screen shot 2012-07-27 at 8.34.27 am.jpg
https://upload.orthobullets.com/topic/4005/images/screen shot 2012-07-27 at 11.56.50 am.jpg
https://upload.orthobullets.com/topic/4005/images/screen_shot_2016-11-26_at_10.34.31_am.jpg
  • summary
    • Humeral Shaft Fractures in the pediatric population are usually traumatic in nature, although nonaccidental trauma and pathologic lesions can not be overlooked.
    • Diagnosis is made with plain radiographs. 
    • Treatment is almost always immobilization due to the high remodeling potential of the pediatric humerus.
  • Epidemiology
    • Incidence
      • represent <10% of humerus fractures in children
  • Etiology
    • Pathophysiology
      • mechanism of injury
        • typically associated with trauma
      • pathomechanics
        • neonates
          • hyper-extension or rotational injury during birth
        • adolescents
          • usually direct trauma
      • pathophysiology
        • consider a pathologic process if fracture is a result of a low energy mechanism
        • may be associated with child abuse if age <3 and fracture pattern is spiral
    • Associated conditions
      • radial nerve palsy
        • associated with up to 5% of humeral shaft fractures
  • Presentation
    • History
      • history of traumatic event
    • Symptoms
      • pain
      • arm deformity
    • Physical exam
      • inspection
        • mid-arm swelling and deformity
        • open fractures are rare
      • palpation
        • tenderness to palpation
      • motion
        • weakness or absence of wrist and digit extension if radial nerve palsy is present
        • pseudoparalysis
          • irritability or refusal to move upper limb in neonates
            • reflexes remain intact
  • Imaging
    • Radiographs
      • recommended views
        • full length AP and lateral views of humerus
      • optional views
        • orthogonal views of shoulder and elbow
          • required to rule out associated injuries
      • findings
        • typical fracture patterns are transverse and oblique
        • examine closely for pathologic lesions
  • Treatment
    • Nonoperative
      • immobilization in splint or brace
        • indications
          • utilized for almost all pediatric humeral shaft fractures (if not pathologic) due to remodeling potential
          • acceptable alignment
            • younger children
              • < 35-45 deg angulation
            • older children
              • < 20 deg varus/valgus
              • < 20 deg procurvatum
              • <15 deg rotation malalignment
              • < 2cm shortening
        • techniques
          • sling and swathe or cuff and collar in young children
          • Coaptation splint or hanging arm cast
          • Sarmiento functional brace in older children/adolescents
          • ROM exercises can be initiated in 2-3 weeks once pain is controlled
    • Operative
      • open reduction internal fixation
        • indications
          • open fractures
          • multiply injured patient
          • ipsilateral forearm fractures
            • "floating elbow"
          • associated shoulder injury
          • unacceptable alignment
        • techniques
          • flexible intramedullary nail fixation
          • anterior, anterolateral or posterior approach with 3.5mm or 4.5mm plate fixation
  • Complications
    • Radial nerve palsy
      • occurs in <5%
        • most commonly associated with middle and distal 1/3 fractures
      • typically due to a neuropraxia
      • spontaneous resolution is expected
      • exploration is rarely needed
        • if function has not returned in 3-4 months, EMGs are performed and exploration considered
    • Malunion
      • rarely produces functional deficits, due to the wide range of motion at the shoulder
        • up to 20-30° of angulation is associated with excellent outcomes
    • Delayed union
      • rare
      • may consider ultrasound bone stimulation
    • Limb length discrepancy
      • commonly occurs, but rarely causes functional deficits
    • Physeal growth arrest
      • proximal and distal humerus growth plates contributes 80:20 percent to overall humeral length
  • Prognosis
    • Excellent
      • associated with enormous remodeling potential and rarely requires surgical intervention
      • up to 20° of angulation is associated with excellent outcomes due to the large range of motion of the shoulder
Card
1 of 38
Question
1 of 5
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options