Humeral shaft fractures in adults

After evaluating the results of treatment of 100 humeral shaft fractures in adults, we found the simplest, most comfortable, and most satisfactory treatment to be that of a sling and coaptive splinting. In all of the 15 patients who had radial nerve injury, the fracture occurred in the distal half of the humerus. Every patient recovered full radial nerve function. At follow-up, almost all patients who were treated nonoperatively were found to have between 3 degrees and 12 degrees of increased internal rotation of the arm, with a corresponding decrease in external rotation. None of the patients had recognized this change before being informed of it. Less than 25 degrees of angulation caused no functional impairment. The fractures were usually clinically united before eight weeks. All of the seven fractures that took longer than six months to heal occurred in the proximal half of the humerus. Three patients accepted nonunion rather than have surgical treatment. All three had oblique fractures in the proximal third of the humerus; two were helped by a brace. The preferred surgical treatment of delayed union or nonunion is secure internal fixation supplemented with autogenous bone grafting.