Internal Trauma, Humeral Fracture, and Radial Nerve Paralysis: How Could it Occur in the Sport Setting? A Case Report and Review of the Literature

Elghoul Naoufal, Elantri Ismail, Bouya Ayoub, Bennis Azzelarab, Zaddoug Omar, Tanane Mansour, Jaafar Abdeloihab


Thrower’s fractures are Spiral fractures of the humerus in the ball. They represent very uncommon clinical entities that can simulate pathologic fractures. Moreover, the concomitant neurologic deficient is rare. Herein we report a 27 years old muscular man presented a spiral fracture of the humerus following a forceful throw of the ball during an amateur throwing challenge. Clinical and imaging findings showed a displaced Thrower fracture with radial nerve neurapraxia (known as Holstein Lewis fracture) prompting the patient to undergo surgery. The intraoperative aspect found that the nerve was near to the beveled distal humeral fragment with no incarceration. We performed an internal fixation using the Leicester plate and the nerve was kept away from the plate by the interposition of a soft tissue sheet. At the last follow up, the fracture united and radial nerve neurapraxia resolved and the patient regained the full range of motion of his right upper limb with no pain. In conclusion, although this type of fracture is rare, given their significant morbidity, we emphasize that the reactional throwers should undergo appropriate preseason training before practicing a throwing challenge or generally a throwing sport.


Thrower’s Fracture, Holstein-Lewis Fracture, Radial Nerve Palsy

Full Text:



Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S. Fractures of the shaft of the humerus. The Journal of Bone and Joint Surgery British volume. 2006;88-B:1469–73.

Wicks E, White A, Marshall S, Hadley C, Dodson C. Missed Thrower’s Fracture of the Humerus in a Pediatric Athlete: A Case Report. The Journal of emergency medicine. 2018;55.

Evans PA, Farnell RD, Moalypour S, McKeever JA. Thrower’s fracture: a comparison of two presentations of a rare fracture. Emergency Medicine Journal. 1995;12:222–4.

Reed WJ, Mueller RW. Spiral fracture of the humerus in a ball thrower. The American Journal of Emergency Medicine. 1998;16:306–8.

Holstein A, Lewis GB. Fractures of the Humerus with Radial-Nerve Paralysis: The Journal of Bone & Joint Surgery. 1963;45:1382–484.

Prucha MG. Thrower’s Fracture of the Humerus: A Case Report. R I Med J (2013). 2018;101:34–5.


Branch T, Partin C, Chamberland P, Emeterio E, Sabetelle M. Spontaneous fractures of the humerus during pitching: A series of 12 cases. Am J Sports Med. 1992;20:468–70.

Ogawa K, Yoshida A. Throwing Fracture of the Humeral Shaft. Am J Sports Med. 1998;26:242–6.

Slocum DB. The mechanics of some common injuries to the shoulder in sports. The American Journal of Surgery. 1959;98:394–400.

Bateman JE. Athletic Injuries About the Shoulder in Throwing and Body-Contact Sports*. Clinical Orthopaedics and Related Research®. 1962;23:75.

Sabick MB, Torry MR, Kim Y-K, Hawkins RJ. Humeral Torque in Professional Baseball Pitchers. Am J Sports Med. 2004;32:892–8.

Gregersen HN. Fractures of the Humerus from Muscular Violence. Acta Orthopaedica Scandinavica. 1971;42:506–12.

Rettig AC, Beltz HF. Stress fracture in the humerus in an adolescent tennis tournament player. Am J Sports Med. 1985;13:55–8.

Shao YC, Harwood P, Grotz MRW, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus. The Journal of Bone and Joint Surgery British volume. 2005;87-B:1647–52.

Curtin P, Taylor C, Rice J. Thrower’s fracture of the humerus with radial nerve palsy: an unfamiliar softball injury. British Journal of Sports Medicine. 2005;39:e40–e40.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine