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
Practice this Topic →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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