Snapshot A 72-year-old woman presents to the emergency room with left arm pain after tripping and falling on the sidewalk. She developed immediate pain throughout her arm. Radiographs of her left arm demonstrate a spiral midshaft humeral fracture. She is given appropriate analgesia and placed in a coaptation splint. Introduction Clinical definition fracture of the humeral shaft Epidemiology Incidence account for approximately 3% of all fractures increasing incidence in the elderly Demographics bimodal age distribution fragility fractures in the elderly high-energy traumatic fractures in younger patients Risk factors osteoporosis Etiology Low-energy injury in elderly patients High-energy injury in younger patients Pathoanatomy normal anatomy bony anatomy login to view 2 more bullets neurovascular anatomy login to view 1 more bullet Associated conditions radial nerve palsy forearm injuries combination of humeral shaft fracture and forearm fractures is termed floating elbow Presentation Symptoms arm pain weakness Physical exam deformity may or may not be appreciated depending on the location and severity of the fracture neurovascular examination before and after reduction is critical to identify radial nerve palsy or deep brachial artery injury radial nerve palsy (5-10%) results in loss of login to view 3 more bullets Imaging Radiography indication always indicated if a humeral shaft fracture is suspected findings fracture patterns can vary login to view 1 more bullet fracture locations can vary login to view 1 more bullet Differential Distal humerus fracture distinguishing factors radiographs will demonstrate a fracture in the supracondylar, lateral condylar, or medial condylar zones of the distal humerus Proximal humerus fracture distinguishing factors radiographs will demonstrate a fracture in the surgical neck or anatomic neck of the proximal humerus commonly injures the axillary nerve login to view 1 more bullet Treatment Nonoperative coaptation splint followed by functional bracing indication login to view 1 more bullet Operative open reduction and internal fixation (ORIF) indication login to view 6 more bullets Complications Nonunion or malunion Radial nerve palsy neuropraxia most resolve over 3 months of observation Prognosis Favorable low-energy injuries Unfavorable delay in rehabilitation high-energy injuries increased likelihood of neurotmesis (complete nerve transection)