You are here

Pediatric Humeral Shaft Fracture S42.399A 812.21

Pediatric Humeral Shaft Fracture

humeral shaft anatomy


Pediatric Humeral Shaft Fracture ICD-10


A- initial encounter for closed fracture

B- initial encounter for open fracture

D- subsequent encounter for fracture with routine healing

G- subsequent encounter for fracture with delayed healing

K- subsequent encounter for fracture with nonunion

P- subsequent encounter for fracture with malunion

S- sequela

Pediatric Humeral Shaft Fracture ICD-9

  • 812.21 (closed fracture of humeral shaft)
  • 812.31 (open fracture of humeral shaft)

Pediatric Humeral Shaft Fracture Etiology / Epidemiology / Natural History

  • May occur from direct blows, falls, MVA, child abuse, birth trauma.
  • More common in children under 3y/o and over 12y/o.

Pediatric Humeral Shaft Fracture Anatomy

Pediatric Humeral Shaft Fracture Clinical Evaluation

  • Pain and swelling in arm after trauma / fall onto outstretched arm. OFten gross deformity.
  • Document NV exam before and after any treatment.

Pediatric Humeral Shaft Fracture Xray / Diagnositc Tests

  • A/P and lateral views of the humerus.

Pediatric Humeral Shaft Fracture Classification / Treatment

  • Location: proximal 1/3, middle 1/3, distal 1/3. Pattern: spiral oblique, transvers, segmental.
  • Acceptable Alignment:
    - <5y/o: 70° angulation, 100% displacement.
    -5-12y/o: 40-70° angulation
    ->12y/o: 40° angulation, 50% displacement, bayonet appostion with <2cm shortening is acceptable.
  • Birth Fracture: Splint in extension. Primary complication is internal rotation deformity.
  • Acceptable aligment: plaster coaptation splint with a collar and cuff sling. May need sedation for reduction. Document NV exam after splinting.
  • Unacceptable alignment: Smooth flexible IM rods (2mm) placed retrograde throught the epicondyles.
  • Open fracture or extensive comminution: consider unilateral external fixation or flexible IM nails.
  • Holstein-Lewis fracture = short oblique fracture of the distal 1/3 of the humerus noted for potential for radial nerve palsy after closed reduction. (Holstein A, JBJS 1963;45A:1382).

Pediatric Humeral Shaft Fracture Associated Injuries / Differential Diagnosis

  • Supracondyle humerus fracture
  • Clavicle fracture
  • Proximal humeral physeal fracture
  • Shoulder dislocation
  • Brachial plexus palsy
  • Septic shoulder / osteomyelitis
  • Child Abuse

Pediatric Humeral Shaft Fracture Complications

  • Malunion: Internal rotation deformity can cause limitations in throwing and facial hygiene.
  • Radial nerve palsy
  • Infection
  • Delayed union / nonunion
  • Fixation failure
  • Compartment Syndrome
  • Median/ulnar nerve palsy: uncommon
  • Limb length discrepancy: overgrowth of the injury extremity is common, generally <1cm.
  • CRPS
  • Refracture

Pediatric Humeral Shaft Fracture Follow-up Care

  • Follow weekly to ensure alignment is maintained and coaptation splint is fitting properly.
  • Generally heals in 6-8 weeks.
  • Avoid contact sports until 6 months after injury.

Pediatric Humeral Shaft Fracture Review References

  • Beaty JH, ICL 1992;41:369
  • °


The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer