Fractures of the humeral shaft: a retrospective study of 240 adult fractures

Abstract

Of 240 humeral fractures, 60 per cent occurred in patients under 35 years old, 39 per cent of fractures being in the middle third of the shaft, 28 per cent were open with an infection rate of 4 per cent. Radial nerve palsy was present in 18 per cent; midshaft fractures accounting for 69 per cent, with 60 per cent of radial nerves recovering spontaneously; 24 per cent after 12 weeks post injury. One hundred and eleven fractures had documentation greater than 3 months. Closed treatment in 100 patients resulted in 5 non-unions and 15 delayed unions; 11 primary internal fixations resulted in 3 non-unions and 2 delayed unions. Subsequent operative procedures reduced the total non-union rate to 5 per cent with 1 per cent delayed union and 4 per cent unknown. Fractures of the humeral shaft that have not begun to unite at 6 to 10 weeks probably will go on to non-union unless the treatment plan is changed. Closed methods of immobilization, other than the sling and swathe, should be used in chronic brain syndrome patients to avoid compounding their fractures. Sixty-three patients with 64 fractures were evaluated in follow-up using Cave's AEF system (92% excellent and satisfactory results) and a modification of Neer's protocol for proximal humeral fractures, (87% excellent and satisfactory results). A functional evaluation on the Cybex machine, (torque through range of motion) gave a useful graphic end result.