Return to Functionality After Humeral Shaft Fracture – Treatment Strategies
DOI:
https://doi.org/10.12775/QS.2026.52.69365Keywords
humeral shaft fracture, surgical approach, athletes, physical rehabilitationAbstract
Background Humeral shaft fractures are relatively common injuries of the musculoskeletal system and occur in the general population and among athletes. They may result from high-energy trauma, falls, overuse, or repetitive microtrauma associated with intensive training. Advances in surgical techniques, fixation materials, and rehabilitation methods have led to the development of new therapeutic strategies that compete with traditional conservative management.
Aim The aim of this review is to analyze the available literature on humeral shaft fractures, with particular emphasis on comparing conservative and surgical treatment, as well as evaluating rehabilitation strategies that influence the time to and quality of return to sports activity.
Material and methods Review of the literature was undertaken using PubMed, Scopus, Google Scholar. Publications in English or Polish focusing on different treatment approach and its results in adult patients were included and evaluated using a qualitative approach.
Results In recent years, this topic has gained increasing attention in sports medicine, especially in relation to overuse injuries and the process of returning to training. The aim of this paper is to present current data on biomechanics, epidemiology, treatment options, and the role of rehabilitation, in humeral shaft fractures. Based on the reviewed literature, both conservative and surgical treatments are associated with high rates of bone union and generally good functional outcomes. Surgical management earlier mobilization and a faster return to sports activity, whereas conservative treatment is linked to a lower risk of surgery-related complications. The choice of treatment method should be individualized.
References
1. Gray H. Gray’s Anatomy for Students. 4th ed. Elsevier; 2021. Chapter 7; Upper Limb
2. Updegrove GF, Mourad W, Abboud JA. Humeral shaft fractures. J Shoulder Elbow Surg. 2018;27:e87–e97.
3. Holstein A, Lewis GM. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am. 1963;45:1382–1388.
4. Shao Y.C., Harwood P., Grotz M.R.W., Limb D., Giannoudis P.V. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005 Dec;87(12):1647–1652. DOI: 10.1302/0301-620X.87B12.16132.
5. Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB. The Shoulder. 5th ed.Elsevier; 2017.
6. Apivatthakakul T, Arpornchayanon O, Bavornratanavech S. Minimally invasive plate osteosynthesis (MIPO) of the humeral shaft fracture. Is it possible? A cadaveric study and preliminary report. Injury. 2005 Apr;36(4):530-538.
7. Kuo Y-R, Ko P-Y, Lee C-Y i in. „Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.” J Orthop Traumatol 2025;26:28
8. Zuckerman JD, Koval KJ. Fractures of the shaft of the humerus. In: Rockwood CA, Green DP, Bucholz RW,Heckman JD, editors. Rockwood and Green’s Fractures in Adults. 4th ed. Philadelphia: Lippincott-Raven; 1996: 1025–1053
9. Tytherleigh-Strong G, Walls N, McQueen M M. The epidemiology of humeral shaft fractures. J Bone Joint Surg Br. 1998 Mar;80(2):249-253. DOI: 10.1302/0301 620X.80B2.8113
10. The Holstein‑Lewis Humeral Shaft Fracture: Aspects of Radial Nerve Injury, Primary Treatment, and Outcome. R. Ekholm, S. Ponzer, H. Törnkvist, J. Adami, J. Tidermark. J Orthop Trauma. 2008 Nov-Dec; 22(10): 693-697. DOI: 10.1097/BOT.0b013e31818915bf.
11. Updegrove GF, Mourad W, Abboud JA. Humeral shaft fractures. Journal of Shoulder
& Elbow Surgery. 2018 Apr; 27(4): e87-e97. DOI: 10.1016/j.jse.2017.10.028.
12. Ogawa K, Yoshida A. Throwing fracture of the humeral shaft: an analysis of 90 patients. American Journal of Sports Medicine.1998 Mar-Apr;26(2):242-246. DOI: 10.1177/03635465980260021401.
13. Operative treatment of torsional humeral shaft fractures in throwers leads to an earlier
return to sport: a survey of expert shoulder and elbow surgeons – Altintas B et al. Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):4049-4054. PMID: 31612264.
14. Benegas E., Amado Ferreira A. Neto, Bolliger Neto R., de Santis Prada F., Angeli Malavolta E., Marchitto G.O. Humeral shaft fractures.Rev Bras Ortop. 2015 Nov 16;45(1):12-16. DOI: 10.1016/S2255-4971(15)30210-X.
15. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA. Functional bracing for the
treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000 Apr;82(4):478-486. DOI: 10.2106/00004623-200004000-00003.
16. Papasoulis E, Drosos GI, Ververidis AN, Verexas DA. Functional bracing of humeral
shaft fractures: a review of clinical studies. Injury. 2010;41:e21–e27.
17. Shields E, Sundem L, Childs S, Maceroli M, Humphrey C, Ketz J, et al. Factors predicting patient-reported functional outcome scores after humeral shaft fractures. Injury. 2015;46:693–698.
18. Koch PP, Gross DF, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg. 2002;11:143–150
19. Denard A Jr., Richards J.E., Obremskey W.T., Tucker M.C., Floyd M., Herzog G.A Outcome of nonoperative vs operative treatment of humeral shaft fractures: a retrospective study of 213 patients. Orthopedics. 2010;33(8):e386-e391. PMID : 20704103
20. Tingstad EM, Wolinsky PR, Shyr Y, Johnson KD. Effect of immediate weightbearing on plated fractures of the humeral shaft. J Trauma. 2000;49:278–280.
21. Korompilias AV, Lykissas MG, Kostas-Agnantzis IP, Vekris MD, Soucacos PN, Beris AE. Approach to radial nerve palsy caused by humerus shaft fracture: is primary exploration necessary? Injury. 2013;44:323–326
22. Paryavi E, Pensy RA, Higgins TF, Chia B, Eglseder WA. Salvage of upper extremities with humeral fracture and associated brachial artery injury. Injury 2014;45:1870–1875.
23. Oliver WM, Molyneux SG, White TO, Clement ND, Duckworth AD. Return to work and sport after a humeral shaft fracture. Bone Jt Open. 2022;3(3):236–244.
24. Zhao JG, Wang J, Wang C, Kan SL. Intramedullary nail versus plate fixation for humeral shaft fractures. Medicine (Baltimore). 2015;94:e599.
25. Goschalk MB, Carpenter W, Hiza E, Reisman W, Roberson J. Humeral shaft fracture fixation: incidence rates and complications as reported by American Board of Orthopaedic Surgery Part II Candidates. J Bone Joint Surg Am. 2016;98:e71.
26. Ma J, Xing D, Ma X, Gao F, Wei Q, Jia H, et al. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: a meta-analysis. PLoS One. 2013;8:e82075.
27. Hashib G. Management of humeral shaft fracture: a comparative study between interlocking nail and dynamic compression plating. Int J Res Orthop. 2016;2:40–47.
28. Christ A.B., Gausden E.B., Warner S.J., Nellestein A.M., Thacher R.R., Lorich D.G. Rotator cuff-sparing approach for antegrade humeral nailing with biceps tenodesis: a technical trick with clinical implications. J Orthop Trauma. 2017 Feb;31(2):e60-e65.
29. Scaglione M, Fabbri L, Dell’Omo D, Goffi A, Guido G. The role of external fixation in the treatment of humeral shaft fractures: a retrospective case study review on 85 humeral fractures. Injury. 2015 Feb;46(2):265-269. DOI: 10.1016/j.injury.2014.08.045.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Mateusz Zbylut, Katarzyna Fabis, Kamila Milewska, Ewa Byjos, Sylwia Buczek, Weronika Mstowska, Karolina Bury, Hanna Naliuka, Katarzyna Mlynarczyk, Patrycja Mateja
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 12
Number of citations: 0
