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Humeral shaft fractures

Nicolas Gallusser

Nicolas Gallusser Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

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Bardia Barimani

Bardia Barimani Division of Orthopedic Surgery, McGill University, Montreal, Canada

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Frédéric Vauclair

Frédéric Vauclair Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

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Humeral shaft fractures are relatively common, representing approximately 1% to 5% of all fractures.
Conservative management is the treatment of choice for most humeral shaft fractures and offers functional results and union rates that are not inferior to surgical management.
Age and oblique fractures of the proximal third are risk factors for nonunion. Surgical indication threshold should be lower in patients older than 55 years presenting with this type of fracture.
Functional outcomes and union rates after plating and intramedullary nailing are comparable, but the likelihood of shoulder complications is higher with intramedullary nailing.
There is no advantage to early exploration of the radial nerve even in secondary radial nerve palsy.

Cite this article: EFORT Open Rev 2021;6:24-34. DOI: 10.1302/2058-5241.6.200033

Article Type:: Review Article

Category:: Shoulder & Elbow

DOI:: https://doi.org/10.1302/2058-5241.6.200033

Volume/Issue:: Volume 6: Issue 1

Open access

Distal humerus nonunion: evaluation and management

Frédéric Vauclair

Patrick Goetti

Patrick Goetti Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland

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Ngoc Tram V. Nguyen

Ngoc Tram V. Nguyen Mayo Clinic, Rochester, Minnesota, USA

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Joaquin Sanchez-Sotelo

Joaquin Sanchez-Sotelo Mayo Clinic, Rochester, Minnesota, USA

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Despite recent improvements in surgical implants and techniques, distal humerus nonunion does occur between 8% and 25% of the time.
Careful identification and improvement of any modifiable risk factors such as smoking, metabolic disorders, immunosuppressant medications, poor nutritional status and infection is mandatory.
A recent computed tomography scan is paramount to determine the nonunion pattern, assess residual bone stock, identify previously placed hardware, and determine whether there is evidence of osteoarthritis or malunion of the articular surface.
Internal fixation is the treatment of choice in the majority of patients presenting with reasonable bone stock and preserved articular cartilage; total elbow arthroplasty is an appealing alternative for elbows with severe destruction of the articular cartilage or severe bone loss at the articular segment, especially in older, female patients. Internal fixation requires not only achieving a stable fixation, but also releasing associated elbow contractures and the liberal use of bone graft or substitutes.
Although reported union rates after internal fixation of distal humerus nonunions are excellent (over 95%), the complication rate remains very high, and unsatisfactory results do occur.

Cite this article: EFORT Open Rev 2020;5:289-298. DOI: 10.1302/2058-5241.5.190050