How would you describe this fracture?
Spiral wedge fracture of the proximal to mid humeral diaphysis with posterior displacement and posterior angulation.
What nerve is most likely to be damaged with this sort of fracture? Why?
The radial nerve runs directly against the periosteum of the posterior part of the humerus in the spiral groove, between the lateral and medial heads of triceps.
How are these fractures usually treated?
Humeral shaft fractures are usually treated with a supportive / hanging cast followed by supportive splint and infrequently require open reduction. Although anatomical reduction is not easily achieved, significant angulation (20 degrees) can be tolerated with little functional impairment. Similarly, up to 3-5cm of shortening is in many cases acceptable.
What are some indications for internal fixation?
A number of indications exist including: adequate alignment cannot be maintained (more commonly encountered in transverse fractures); open fractures; presence of vascular injury; presence of significant other injuries (poly-trauma, brachial plexus injury); non-union; pathological fracture.
Spiral wedge fracture of the proximal to mid humeral diaphysis. The distal fragment is slightly posteriorly displaced and angulated. The shoulder and elbow remain enlocated.