Humerus Fracture

Humerus Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Proximal humeral fractures:
    • Typically described as nondisplaced, displaced, and/or fracture/dislocation
    • Account for 5% of all fractures
    • Increased incidence with age
    • 4:1 female to male
    • Vast majority of patients are >60 yr old
    • 3rd most common osteoporotic fracture, after hip and distal radius fractures
    • Neer classification: A system that identifies the number of fragments and their location:
      • Fractures consist of 2–4-part fractures; the locations include the anatomic neck, surgical neck, greater tuberosity, and lesser tuberosity.
      • Fracture/dislocations also part of the Neer classification
  • Humeral shaft fractures:
    • Account for <3% of fractures
    • May be spiral, oblique, or transverse
    • Humeral shaft fractures (AO classification):
      • Simple
      • Wedge
      • Comminuted (complex)

Etiology

  • Proximal humerus fractures:
    • Most often a history of a fall (low energy)
    • Most common is fall on outstretched hand
    • Less common is violent muscle contraction from shock or seizure or higher-energy injury
  • Humeral shaft fractures:
    • High-energy direct trauma (penetrating or blunt) or bending force
    • Less common from fall
    • Stress fractures from throwing injury

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Basics

Description

  • Proximal humeral fractures:
    • Typically described as nondisplaced, displaced, and/or fracture/dislocation
    • Account for 5% of all fractures
    • Increased incidence with age
    • 4:1 female to male
    • Vast majority of patients are >60 yr old
    • 3rd most common osteoporotic fracture, after hip and distal radius fractures
    • Neer classification: A system that identifies the number of fragments and their location:
      • Fractures consist of 2–4-part fractures; the locations include the anatomic neck, surgical neck, greater tuberosity, and lesser tuberosity.
      • Fracture/dislocations also part of the Neer classification
  • Humeral shaft fractures:
    • Account for <3% of fractures
    • May be spiral, oblique, or transverse
    • Humeral shaft fractures (AO classification):
      • Simple
      • Wedge
      • Comminuted (complex)

Etiology

  • Proximal humerus fractures:
    • Most often a history of a fall (low energy)
    • Most common is fall on outstretched hand
    • Less common is violent muscle contraction from shock or seizure or higher-energy injury
  • Humeral shaft fractures:
    • High-energy direct trauma (penetrating or blunt) or bending force
    • Less common from fall
    • Stress fractures from throwing injury

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