Immediate Treatment of Neonatal Humeral Shaft Fractures
Treatment of humeral shaft fractures in newborns should begin immediately upon diagnosis, with simple immobilization by swaddling or gentle manipulation with casting, as these fractures demonstrate complete union within 2 weeks and full remodeling by 6 months regardless of initial deformity. 1, 2
Diagnostic Approach
- Diagnosis should be made on the first day of life using both radiography and ultrasonography, with ultrasound being particularly valuable for detecting fractures in the yet-unossified epiphyses 1
- Ultrasonography is simple, readily available, and inexpensive for birth-related humeral fractures 1
Treatment Protocol
Immediate Management (Day 1)
- Begin treatment immediately upon diagnosis with the simplest immobilization methods 1, 2
- For humeral shaft fractures: gentle manipulation and casting or simple swaddling 1, 2
- No attempt at anatomical reduction is necessary given the tremendous remodeling capacity in neonates 2
Acceptable Deformity Parameters
- Even severe angulation up to 66 degrees remodels to near-normal alignment (5 degrees) by 7.3 months 2
- Mean initial angulation of 26 degrees coronal and 25 degrees sagittal remodels to 5 degrees coronal and 7 degrees sagittal at final follow-up 2
- The tremendous capacity for remodeling in infants eliminates the need for complex immobilization methods 2
Expected Outcomes
- Fracture union occurs within 2 weeks in all cases 1
- Complete radiographic remodeling is demonstrated by 6 months of age 1
- Nonoperative management is uniformly successful for birth-related humeral shaft fractures 1, 2
Critical Clinical Caveat
Operative intervention is never indicated for neonatal humeral shaft fractures - the evidence consistently shows that even severely displaced or angulated fractures remodel completely with simple immobilization alone 1, 2. Any consideration of more aggressive treatment represents overtreatment given the predictable excellent outcomes with conservative management.