OR2.4 | Humeral Shaft Fracture with Neurovascular Risk — Summary & Reflection

KEY TAKEAWAYS

Humeral shaft fractures are managed primarily non-operatively with a hanging-arm cast transitioning to a functional fracture brace (Sarmiento), achieving union in ~90% of closed fractures. The radial nerve runs in the radial groove of the posterior humerus and is at risk in ~12% of humeral shaft fractures, rising to ~22% in Holstein-Lewis distal-third spiral fractures. Wrist drop (failure of wrist and finger extension) and anaesthesia of the first dorsal web space confirm radial nerve injury. Primary palsies (present before manipulation) are managed expectantly with a cock-up splint; secondary palsies (post-manipulation) warrant exploration. Operative indications include open fracture, polytrauma, floating elbow, vascular injury, and secondary radial nerve palsy. Intercondylar (T-condylar) distal humerus fractures require ORIF with dual-column plating and ulnar nerve visualisation. Open fracture antibiotic rule: within 1 hour.

REFLECT

Imagine you are the first doctor seeing a patient with a confirmed humeral shaft fracture who has intact radial nerve function. After a colleague performs closed reduction under sedation, you review the patient and find wrist drop. The colleague is convinced 'it must have been there before.' How would you approach this situation clinically (patient care) and professionally? What documentation should have existed, and what immediate action is now required? Reflect on the importance of systematic neurovascular documentation as both a clinical and medico-legal discipline.