71.16 Fractures of the shaft of the humerus

Babies

A baby’s humerus is often fractured during a difficult delivery, or in a non–accidental injury. It heals rapidly with massive callus formation and needs no treatment. Bind his arm loosely to his chest wall for a week to prevent further injury. At the end of a year there will be no trace of the fracture.

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Figure 71.15: TREATING A FRACTURE OF THE SHAFT OF THE HUMERUS. A, how it should not be done. This heavy cast will press on the patient’s forearm and distract the bone ends. B, a properly treated patient exercising his shoulder. C, the same patient exercising his elbow. D, non–union after a fracture 30 years before. This patient had suprisingly little disability. E, success. F, failure. Kindly contributed by Peter Bewes.

Adults

Fractures of the shaft of the humerus are not common again until adult life. They are of many kinds, but you can treat them all in the same way. If you do this properly, they cause no problems. Union is the first priority, then elbow movement. Moderate angulation is no disability.

Put the patient’s arm in a narrow sling, as in C, and E, Fig. 71-15, so that half the weight of his forearm acts on the lower fragment to reduce overlap and angulation. Put his arm across his chest to correct rotation. The muscles attached to his humerus will hold the fragments in place. Overlap and shortening are unimportant. In young children they are even desirable. There are no indications for internal fixation unless the patient also has other injuries, or must be back at work quickly.

Some surgeons (including ourselves) treat these fractures without a splint, and argue that a little movement is a good thing in fractures of the shaft of the humerus because it promotes union; others splint them to reduce pain, and protect the patient’s arm in case he should fall. The ideal splint is a stiff, light cuff with ’Velcro’ fastenings, which will allow active shoulder and elbow movement. Failing this, you can apply a light U–slab, or you can use strips of bamboo as described below. If you use a plaster splint, it must be a light one, or its weight will distract the fragments and cause non–union. The traditional splint in Fig. 56-1 is admirable.