Humeral fractures

Abstract

Humeral fractures are challenging injuries to deal with. Thorough patient assessment is necessary on presentation, to evaluate for concurrent injuries and to rule out pathologic fractures. External coaptation is not considered a viable treatment option for the vast majority of humeral fractures and surgical stabilisation is recommended. Humeral fractures are classified as proximal, midshaft and distal, with various sub-classifications within each category. Fractures of the greater tubercle and humeral head are generally stabilised using a tension band apparatus and additional K-wires or lag screws where necessary. Humeral neck fractures are commonly transverse and amenable to compression plate fixation craniolaterally, but for comminuted fractures a form of bridging fixation is required. Fractures of the midshaft of the humerus can be repaired via a range of fixation strategies including plates, external skeletal fixation, interlocking nails, intramedullary pins and cerclage wires, and combination techniques. Distal humeral fractures include those of the medial or lateral humeral condyle, commonly stabilised using a transcondylar screw and a supracondylar K-wire or plate, and intracondylar fractures, which are challenging and commonly stabilised using bilateral plate fixation in conjunction with a transcondylar screw. The prognosis following humeral fracture stabilisation is generally good to excellent although the articular fractures, particularly the intracondylar fractures may have a slightly more guarded prognosis for long-term resolution of lameness.