The radiograph (Figure 2) revealed a minimally displaced pathologic fracture (red arrow) through the midshaft of the humerus, which resulted from a space-occupying lesion (green arrow) in the humeral diaphysis. Since the radial nerve is commonly affected in this type of injury due to its close proximity to the humeral midshaft, careful neurologic assessment at the wrist and hand is essential. Injury to the nerve can occur during the fracture or reduction of the fracture, causing weakness in the extensors of the hand and numbness in the first dorsal web space. The incidence of radial nerve palsy in midshaft fractures of the humerus is 16%.1
Figure 2
In nondisplaced or minimally displaced fractures of the humeral midshaft, conservative management with a U-shaped (sugar-tong) splint from axilla to shoulder with elasticized wrap and sling is recommended. Surgical management is indicated in comminuted, significantly displaced, nonreducible, pathologic cases or in fractures resulting in neurovascular compromise. The patient in this case was referred to an orthopedic surgeon for open treatment.