Abstract
Humeral shaft fractures are rare in childhood, accounting for less than 5% of all pediatric fractures. Indirect trauma predominates in younger children, whereas direct trauma is more common in older patients. To date, no uniform recommendations exist regarding diagnostic evaluation or treatment management. Therefore, during the 13th and 14th scientific meetings of the Pediatric Traumatology Section (SKT), the available evidence was reviewed, the management strategies were critically discussed within an expert panel and a consensus was formulated.The management remains predominantly conservative, although the number of surgically treated cases is increasing. Potential humeral length discrepancies are generally clinically not a problem, whereas angular deformities exceeding 10° are cosmetically relevant. Owing to the extensive range of motion of the shoulder, functional impairment is generally not expected. In conservative treatment immobilization is recommended for 3-6 weeks, depending on the fracture type and patient age. Absolute indications for operative intervention include open fractures (> type II), unstable multilevel injuries of the affected arm and severe soft tissue damage that precludes adequate immobilization. Relative indications comprise polytrauma, traumatic brain injury, multiple or bilateral injuries, simple transverse fractures due to inherent instability and prolonged healing, anticipated noncompliance and patient preference. Elastic stable intramedullary nailing (ESIN) represents the gold standard for surgical management. Typical complications include radial nerve injury, technical difficulties during fixation and nonunion.Traumatic radial nerve palsy occurs in approximately 4% of cases. The treatment approach selected based on fracture morphology should be maintained. Primary nerve exploration is not initially required. High-resolution ultrasonography of the radial nerve should be performed within 1-2 weeks in both primary and secondary palsy. Nonstructural lesions typically recover spontaneously within 3-6 months. Early physiotherapy and occupational therapy are recommended in the presence of nerve deficits. In cases of an inadequate trauma mechanism, pathological fractures or potential indicators of child abuse must be considered.