Management of Humeral Shaft Fracture in an 11-Year-Old
Yes, an 11-year-old with a humeral shaft fracture requires immobilization with either a functional splint or coaptation splint initially, followed by functional bracing for definitive nonoperative management. 1, 2
Initial Immobilization Approach
For acute management, use a functional splint rather than a traditional coaptation splint as it provides equivalent fracture reduction while being easier to apply, better tolerated by patients, and requiring less application time. 3 Both splint types achieve similar fracture angulation and translation control on radiographs, but functional splints offer practical advantages in the emergency setting. 3
Treatment Algorithm Based on Fracture Characteristics
Nonoperative Management (First-Line Treatment)
- Most humeral shaft fractures in children should be treated nonoperatively with functional bracing, which has been the standard of care since the 1970s. 1
- Functional bracing is appropriate for closed fractures without significant displacement or angulation. 1, 2
- Humeral shaft fractures in children have excellent remodeling potential, particularly in the 11-year-old age group. 2
Indications Requiring Surgical Intervention
Surgical management is indicated when any of the following are present: 1, 2
- Angulation exceeding 10 degrees after reduction 4
- Open fractures 1, 2
- Vascular injury 1
- Multiple trauma/polytrauma 1, 2
- Bilateral humeral fractures 2
- Compartment syndrome 2
- Pathological fracture (e.g., unicameral bone cyst) 4, 2
- Floating elbow injuries 1
- Ipsilateral articular fractures 1
- Failure of nonoperative management 1
Surgical Options for 11-Year-Olds
When surgery is required, elastic stable intramedullary nailing (ESIN) is the preferred method for this age group. 4 In adolescents approaching skeletal maturity, unreamed interlocking intramedullary nails may also be considered. 4
Critical Pitfall: Radial Nerve Assessment
Always perform and document a thorough radial nerve examination before and after any manipulation or immobilization. 1, 5
- Primary radial nerve palsy (present at initial injury) is not an automatic indication for surgical exploration in pediatric patients. 4
- However, nerve exploration may be warranted in specific fracture patterns with high suspicion for nerve laceration or entrapment. 4
- Ultrasound can reliably detect radial nerve contusion, entrapment, or laceration with accuracy comparable to intraoperative findings. 5
Special Consideration: Rule Out Pathological Fracture
In an 11-year-old with humeral shaft fracture from minor trauma, strongly consider occult unicameral bone cyst as the underlying cause. 2 Review radiographs carefully for lytic lesions, as pathological fractures may require different management including ESIN stabilization. 4