Humeral Shaft Fractures
Radial nerve, bracing, and operative indications.
Aug 15, 2026 · 3 refs
At a glance
Most closed humeral shaft fractures heal with functional bracing when alignment is acceptable and the patient can be followed. The radial nerve exam is the line you write twice — before and after any manipulation or surgery.
Operative care is for the fracture or the patient that will not succeed in a brace, not for every spiral on an x-ray.
Decision-making
Document radial nerve status clearly. Primary palsy is usually observed with closed treatment; palsy after manipulation or that appears post-fixation needs a specific plan.
Indications that commonly push toward ORIF / nailing include open fractures, vascular injury, floating elbow, polytrauma needing upper-extremity weight bearing, unacceptable alignment after bracing, and certain pathologic fractures.
Treatment
- Coaptation splint then functional brace for many closed fractures
- Serial radiographs for alignment and callus
- ORIF (often plate) when operative indications are met; nails in selected patterns
- Explore the nerve when intraoperative findings or post-op palsy demand it per the clinical scenario
High-yield / exam
- Radial nerve exam before and after
- Many shafts succeed with bracing
- Holstein-Lewis pattern association with nerve injury is classic exam bait
- Open fracture and floating elbow push operative
Questions
On call and Boards items for this topic are coming.
Open the bank →Your pearl
One line you’d tell a junior at 2am.
References
- 01
Functional bracing of fractures of the shaft of the humerus
Sarmiento A et al. · 1977 · Journal of Bone and Joint Surgery (American) · review
Foundational evidence for functional bracing of humeral shaft fractures.
- 02
Humeral shaft fractures — bracing versus operative treatment
2015 · Journal of the American Academy of Orthopaedic Surgeons · review
Summarizes operative indications and radial nerve decision-making.
- 03
OTA teaching on humeral shaft fractures and radial nerve palsy
2019 · Orthopaedic Trauma Association · guideline
Emphasizes documentation of nerve status and selective operative care.
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