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Pediatric Humeral Shaft Fracture S42.399A 812.21

Pediatric Humeral Shaft Fracture

humeral shaft anatomy

synonyms:

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
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