Incidence- Fall from a height or a direct impact as in vehicular accidents.

Diagnosis

·                 Swelling, pain and bruises are common features

·                 The arm may appear shortened and deformed if the fracture is significantly displaced.

·                 Inability to extend the wrist (wrist drop) and sensory deficit over the base of thumb on the dorsal aspect indicates an associated injury to radial nerve

·                 A thorough assessment of peripheral neurovascular status is essential in all humeral shaft fractures

·                 Associated injuries to the shoulder and elbow joints are not uncommon

Investigations

·                 X-rays (AP and Lateral) of the entire humerus should be taken to confirm the diagnosis

·                 CT is rarely indicated

Most humeral shaft fractures (>90%) will heal with non surgical management.

Twenty degrees of anterior angulation, 30 degrees of varus angulation and up to 3 cm of bayonet apposition are acceptable and will not compromise function or appearance.

Management

Conservative —for undisplaced fractures in the form of hanging castor U- slab

The patient must remain upright or semi upright most of the time with the cast in a dependent position for effectiveness

It is frequently exchanged for functional bracing 1 or 2 weeks after injury Union occurs in more than 90% of cases

Patients with associated neurovascular injury or in unstable fractures where facilities are not available for ideal internal fixation should be referred to higher centres.