Paediatric Humeral Shaft Fracture
Paediatric humeral shaft fractures are uncommon and account for 2-5% of all fractures in children.
Humeral shaft fractures are the second most common birth fracture.
Humeral shaft fractures are classified by –
Anatomical location – proximal, middle and distal third
Fracture pattern – spiral, short oblique, transverse or comminuted
Degree of displacement – Undisplaced or displaced
Presence of soft tissue damage – open or closed
Transverse and short oblique fractures are generally the result of direct trauma, whereas spiral fractures are due to twisting injury.
Pathological fractures through a humeral simple bone cyst are relatively common after minimal trauma in children over 7 years of age.
Spiral fractures of the humerus in infants and toddlers are strongly linked with non-accidental injury.
Infantile injuries are presented with complaints of not using the arm and deformity over the arm.
Older children present after a defined injury with pain and loss of movement around the shoulder and elbow.
On examination, the arm is usually swollen and tender.
Crepitus may be present.
Radial nerve palsy can occur with a fracture at the junction of the middle and distal thirds of the shaft. There will be loss of finger metacarpophalangeal extension and loss of wrist extension. The sensory loss will be in the dorsum of 1st webspace.
All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified.
Standard anteroposterior and lateral radiograph views of the humerus should be obtained.
Fractures of the humeral shaft are often either transverse fracture or spiral. Look for evidence of bone cyst or other pathologic fracture.
The reduction is seldom required.
Fractures will usually hang out under the influence of gravity to good alignment and apposition using a collar and cuff or U-plaster cast or hanging cast.
Operative interventions are indicated in the following situations –
Neurovascular injury with fracture
Extreme swelling/compartment syndrome – extremely rare with humeral fracture
Pathological fracture (simple bone cyst, Aneurysmal bone cyst)
Pain from the fracture and restriction of movement is usual for 2-3 weeks and will require regular analgesia.
The family should be advised to re-attend if the pain is increasing or sensation changes abruptly.
Strong periosteal healing and remodelling usually result in excellent function and cosmesis.
Radial nerve injury is uncommon. These injuries usually recover spontaneously and treatment is supportive with wrist and dynamic finger splintage.
Malunion is usually cosmetic and rarely functional.
Non-union are rare.