Synopsis
Stabilise humeral-shaft fracture, document radial and wider neurovascular function accurately, distinguish primary from new iatrogenic palsy, and select functional bracing, fixation or nerve exploration safely.
- Inspect the whole arm for wounds, deformity and skin pressure and examine shoulder and elbow because associated joint injury changes care.
- Before and after splintage, test wrist extension, finger MCP extension, thumb extension, dorsal first-web sensation, median and ulnar functions, pulses and refill.
- Obtain AP and lateral radiographs of the full humerus including shoulder and elbow; pathological features may require staging before definitive fixation.
Key red flags
A cool hand, absent pulse, expanding arm haematoma or recurrent bleeding requires immediate realignment and combined vascular and orthopaedic assessment.
Arm pain, swelling, shortening, angulation and crepitus follow direct or torsional trauma.
Investigation priorities
Define fracture and include both shoulder and elbow joints.
Management branches
A humeral-shaft fracture is suspected after trauma.
- Use ABCDE for high energy, expose wounds and inspect shoulder, arm and elbow.
- Give analgesia and document pulses and radial, median and ulnar motor and sensory findings.
Key medicines
Paracetamol for adult arm-fracture painFor an adult, prescribe 500 mg to 1 g orally as required, with a minimum 4-hour interval and a maximum of four administrations in one day.
Intravenous prophylaxis for an open humerusGive the locally approved intravenous open-fracture agent and dose as soon as possible and within 1 hour, adjusted for allergy, renal function and contamination.