Humeral shaft fractures : epidemiology outcome

Humeral shaft fractures account for 1-3% of all fractures and approximately 20% of all humeral fractures. Non-operative treatment with functional bracing has been regarded as the golden standard for treatment of closed humeral shaft fractures with studies reporting a high overall healing rate and an acceptable functional outcome. Injury to the radial nerve in patients with humeral shaft fractures is the most common nerve lesion complicating fractures of long bones, and historically the Holstein-Lewis fracture, i.e. a simple spiral fracture in the distal third of the shaft, has been regarded as a strong indication for open reduction and internal fixation due to its association with radial nerve injury. However, there are only a few modern studies reporting the results after non-operative treatment, the outcome after primary radial nerve palsy and the outcome after a Holstein-Lewis fracture with a longer follow-up including patient-reported outcomes regarding function and the health-related quality of life (HRQoL).

The epidemiology of humeral shaft fractures in Stockholm was reported in a study comprising 397 consecutive patients with 401 fractures (Study I). It provided recent epidemiological data on humeral shaft fractures in a population with a limited amount of high-energy and penetrating trauma, probably reflecting a situation that prevails in most European countries. These data can be used to facilitate the planning of treatment for patients with this particular fracture.

In the sample of 397 patients, 78 consecutive patients at Södersjukhuset with a humeral shaft fracture initially treated non-operatively were identified (Study II). Data on fracture healing was collected from the medical charts. The patients were assessed prospectively regarding functional outcome and HRQoL. The study confirmed the high overall rate of union of humeral shaft fractures and an acceptable functional outcome after successful fracture-brace treatment. In simple fractures (Type A), the non-union rate seemed to be higher, and patients with healed non-unions after revision surgery had worse functional outcomes.

Thirty-three of the 397 patients with a humeral shaft fractures had primary radial nerve palsy (Study III). Data on the primary treatment modality, i.e. operative or non-operative, recovery of radial nerve function and fracture healing were collected from the medical charts. The patients were assessed prospectively regarding functional outcome and HRQoL. The study confirmed the high spontaneous recovery rate of primary radial nerve palsies in patients with closed humeral shaft fractures, regardless of the treatment modality. Primary radial nerve palsy should not be regarded as an isolated indication for primary surgical intervention.

Twenty-seven of the 397 patients with a humeral shaft fracture had a Holstein-Lewis fracture (Study IV). Data on the primary treatment modality, i.e. operative or non-operative, recovery of radial nerve function and fracture healing were collected from the medical charts. The patients were assessed prospectively regarding functional outcome. The study showed that the Holstein-Lewis humeral shaft fracture was associated with a significantly increased risk of primary radial nerve palsy. The overall outcome regarding radial nerve recovery, fracture healing and function was excellent regardless of the primary treatment modality, i.e. operative or non-operative. The indication for primary operative intervention in this specific fracture type appeared to be relative.

List of scientific papers

I. Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S (2006). "Fractures of the shaft of the humerus. An epidemiological study of 401 fractures." J Bone Joint Surg Br 88(11): 1469-73
https://pubmed.ncbi.nlm.nih.gov/17075092

II. Ekholm R, Tidermark J, Törnkvist H, Adami J, Ponzer S (2006). "Outcome after closed functional treatment of humeral shaft fractures." J Orthop Trauma 20(9): 591-6
https://pubmed.ncbi.nlm.nih.gov/17088659

III. Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark J (2007). "Primary radial nerve palsy in patients with acute humeral shaft fractures." (Submitted)

IV. Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark J (2007). "The Holstein-Lewis humeral shaft fracture. Aspects of radial nerve injury, primary treatment and outcome." (Submitted)