1.Overview
A humeral stem fracture is generally defined as a fracture between 2 cm below the surgical neck of the humerus and 2 cm above the humeral condyle, accounting for approximately 1.31% of all fractures in the body. Humeral stem fracture can be caused by direct or indirect violence.
2.Clinical manifestations and diagnosis
After the injury, pain, swelling, deformity, subcutaneous ecchymosis, and upper limb movement disorder appear in the upper arm. On examination, pseudo-articular movement, bone rubbing sensation and reduced or absent bone conduction sounds can be found. Auxiliary X-ray examination can clarify the diagnosis.
3.Common complications after humeral stem fracture
(1) Radial nerve injury (there is a radial nerve groove on the posterior side of the middle and lower 1/3 of the backbone, which is often combined with injury during fracture)
(2) Vascular injury (brachial artery)
(3) Non-healing
4.Classification
No one classification of humeral stem fractures is widely accepted. Fractures are generally classified on the basis of factors affecting treatment. For example.
①Fracture site
②The direction and characteristics of the fracture line
③Combined soft tissue injury status
④Combined periarticular injuries
⑤ Combined nerve injury
(6) Combined vascular injury, etc.
5.Treatment
The purpose of treatment for humeral stem fracture is to obtain bony healing, good alignment and restoration of the patient’s pre-injury function.
(1) Non-surgical treatment
Most humeral stem fractures can be treated non-operatively and achieve a healing rate of 90% or more. These methods include draped cast fixation, “U” shaped cast fixation, taping fixation, external booth recognition cast fixation, bone traction fixation, functional brace braking, etc.
(2) Surgical treatment
The indications for surgery of humeral stem fracture include: open fracture, combined vascular injury, floating elbow, multi-segment fracture, pathological fracture, bilateral humeral stem fracture, multiple fractures, etc. Surgical repositioning and fixation modalities include plate and screw fixation (Figure 1), external fixation brace fixation (Figure 2), intramedullary fixation (Figure 3)
(Figure 1)
(Figure 2)
(Figure 3)