In some situations, humeral shaft fractures can be associated with neurological injuries. Most frequently the radial nerve is affected. Less frequently other nerves are involved:
The likelihood of an additional nerve injury depends on:
Since many radial nerve lesions recover spontaneously and do not require any surgical treatment, it is important to differentiate between nerve disruption and neurapraxia to decide whether to explore the nerve or not.
Nerve exploration should be considered under the following situations:
When planning nerve exploration, be prepared for neurosurgical procedures such as readaptation or grafting.
Humeral shaft fractures may be associated with vascular injuries. Most frequently the brachial artery is affected. Those injuries are emergency cases and require quick and straight forward diagnostics and therapy.
If no peripheral pulses can be detected, further, immediate imaging is mandatory either by arteriography or iv contrast CT scans.
In major vascular injuries, immediate fixation of the fracture with external fixation and additional vascular surgery (eg direct repair or grafting) is the treatment of choice. Definitive fixation using a plate or nail is rarely performed initially. Be aware of perfusion-reperfusion damage and later compartment syndrome.