humerus fracture in Tunisia

Definition of Humerus Fracture

Fracture of the humeral shaft and proximal metaphysis can be due to trauma, including birth trauma, accidental and non-accidental injuries. Pathological fractures may be associated with bone disease, benign lesions such as unicameral bone cysts and aneurysmal bone cysts, or malignant lesions such as osteosarcoma or Ewing's sarcoma. Repetitive trauma can cause stress fractures.

Humerus Anatomy

The humeral shaft is covered with muscle on all sides, contributing to good blood circulation and high union rates. The extensive range of motion at the shoulder helps patients compensate for relatively significant angular deformity of the humeral shaft.

Non-Surgical Treatment of Humerus Fracture

Non-operative treatment of humeral shaft fractures includes three phases: initial splinting, functional bracing or casting, and rehabilitation.
Initially, the arm is usually immobilized at 90 degrees of elbow flexion with a coaptation splint that extends from the medial aspect of the armpit, around the elbow, over the lateral aspect of the shoulder, and up to the neck. The purpose of the coaptation splint is to stabilize the fracture and thus improve patient comfort. The coaptation splint uses dependent traction and hydrostatic pressure to maintain fracture reduction and is indicated for fractures with minimal shortening and for short oblique or transverse fracture patterns. Coaptation splints are heavy for patients and may be associated with pressure sores, so they should only be used in initial treatment, as a bridge to functional bracing or hanging cast.

Surgical Alternatives for Humerus Fracture

Open reduction and internal fixation are recommended for open fractures (except low-velocity gunshot fractures), fractures associated with vascular injuries, and unstable combined fractures of the arm and forearm (the so-called 'floating elbow'). Surgery is also considered in patients with multiple injuries to allow weight-bearing on the affected arm for ambulation with functional devices and aids.
Most open fractures and high-velocity gunshot injuries should be treated with irrigation and debridement in the operating room, followed by internal fixation. Fractures with intra-articular extension also benefit from surgery, as discussed elsewhere in this book. A fracture with overlying burns should be considered for operative treatment due to the increased risk of compartment syndrome and because the skin condition may not be ideal for casting or bracing.
The risks and benefits of operative treatment should be discussed and the decision shared with each patient. Operative fixation generally allows for faster return to function, but it also carries a risk of nerve injury, infection, implant failure, and other surgical complications. Operative fixation options include plate osteosynthesis, intramedullary nailing, and external fixation. Plating options and techniques include open reduction with conventional plates or locking plates and screws and minimally invasive plate osteosynthesis.
The majority of humeral shaft fractures are accessible and plated through an anterolateral or posterior approach. More rarely, a direct medial or direct lateral approach may be used.