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Clinical Practice Guidelines

Humeral shaft fractures - Fracture clinics

  • Fracture Guideline Index

    See also: Humeral shaft fractures - Emergency Department

    1. How often should these fractures be followed up in fracture clinics?
    2. What should I review at each appointment?
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion?
    5. What are the indications for discharge?

    1. How often should these fractures be followed up in fracture clinics?

    Table 1:  Recommended follow-up schedule for humeral shaft fractures.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Midshaft humeral - non-comminuted

    At 1 week post-injury with x-ray

    At 3 weeks post-injury with x-ray

    Basic hanging of the fracture is usually enough in the first 2 weeks. Functional bracing may be required to facilitate activity and function

    6 weeks post-injury.  Clinical examination

    Excellent outcome is expected

    Physiotherapy is not usually required

    Midshaft humeral - comminuted

    At 1 week post-injury with x-ray

    At 2 weeks post-injury with x-ray

    At 4 weeks post-injury.  Clinical examination

    At 6 weeks post-injury.  Clinical examination

    		  

     

     2. What should I review at each appointment?

    Check for pain and position of collar and cuff.

    Assess and document neurovascular status.

    Assess need for bracing to support fracture and allow more hand function.

    Check x-ray for stability of union to determine timing of active mobilisation.

    3. What are the potential complications associated with this injury?

    1. Neurological injury with deficit - expect neuropraxia to resolve over weeks to months
    2. Malunion - is usually cosmetic and rarely functional
    3. Nonunion - rare
    4. Growth disturbance and degenerative change are not associated with isolated middle third humeral fractures

    4. When should I refer for an orthopaedic consultant opinion?

    Delayed radiographic union - greater than 8 weeks.

    Neurological deficit - needs to be carefully assessed and monitored.

    5. What are the indications for discharge?

    Clinical union (defined by no pain/tenderness or movement at fracture site) in an appropriate time frame (6-8 weeks).

    Radiographic union if follow-up x-rays are taken.

    No residual neurological deficit.

    References (Outpatient setting)

    Hunter JB. Fractures around the shoulder and humerus. In Children's Orthopaedics and Fractures,3rd Ed. Benson M, Fixsen J, Macnicol M, Parsch K (Eds). Springer, London 2010. p.717-30.

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    Content developed by Victorian Paediatric Orthopaedic Network.  To provide feedback, please email rch.orthopaedics@rch.org.au