Holstein-Lewis fracture

Last revised by Dr Daniel J Bell on 23 May 2022

Holstein-Lewis fractures represent a special type of humeral shaft fracture. It is a simple spiral fracture of the distal humerus with a radial displacement of the distal fragment 1,3,4. These fractures are reported to have a higher rate of radial nerve palsy when compared to other humeral shaft fractures 1-4.

Holstein-Lewis fractures account for ~7% of all humeral shaft fractures, which have a bimodal distribution: young adults and elderly females (most common) 1,3.

Common mechanisms of trauma of humeral shaft fractures are 1,3:

  • fall (elderly population)
  • motor vehicle collision

The radial nerve courses near the humeral shaft and is not protected by interposed muscle inferolaterally across the posterior aspect of the arm before going through the lateral intermuscular septum into the anterior compartment. The location at which there is the highest chance of radial nerve damage is on average 10 cm from the distal articular surface of the elbow, and no closer the 7.5 cm 3,4.

Radiographs are frequently enough on their own to make a diagnosis of a Holstein-Lewis fracture.

The spiral fracture line is usually evident. The fracture is located in the distal to the middle third of the humeral shaft. There is radial (lateral) displacement of the distal fragment 1,3,4.

These fractures were initially described as an absolute indication of operative treatment. More recent studies however show evidence that a non-operative approach may be adequate in some instances 2,4.

Although Holstein-Lewis fractures have a higher rate of radial nerve palsy (22% compared to the 8% of other humeral shaft fractures) good radial nerve recovery is usually achieved regardless of whether the management was operative or not 2,4.

In 1963, the American orthopedic surgeons Arthur Holstein (1914-2000) and Gwilym B Lewis (1914-2009) described this pattern of fracture with an increased risk of radial nerve palsy 5.

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Cases and figures

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