Clinical evaluation
1. General considerations
Humeral shaft fractures in children are relatively rare (2–5% of all fractures).
Most fractures are caused by falls from a height or direct trauma, eg, vehicle collisions.
The pattern of injury depends on the age of the child as well as the mechanism and direction of force.
2. History
A careful history should include the mechanism of injury and consider nonaccidental injury in younger children with reports from any witnesses.
3. Patient assessment
Symptoms and signs
The main symptoms are pain and restricted arm movement.
The signs include:
- Swelling
- Bruising
- Tenderness
- Deformity
- Wrist drop (due to radial nerve injury)
Physical examination
Injuries at other sites should always be considered, especially in high-energy trauma. In such cases the patient should be assessed using standard algorithms (ATLS).
The soft-tissue envelope, and vascular and neurological status of the limb must be accurately assessed and recorded. This should occur after any injury but is particularly important after a high-energy mechanism and significant fracture displacement.
