Atraumatic Fractures of the Humerus Associated With Throwing Whilst Playing Dodgeball: A Case Series and Review of the Literature


1 Sydney Medical School, University of Sydney, Sydney, Australia

2 Department of Orthopedic Surgery, Concord Repatriation General Hospital, Sydney, Australia


Five patients presented to the emergency department of a tertiary referral teaching hospital with atraumatic fractures of their humerus sustained during a recreational dodgeball tournament.

Case Presentation
The patients were young healthy individuals that described the fracture occurring during the act of throwing.

The causes leading to fracture of the humerus during the act of a throw are discussed and the management strategies utilized.


1. Kuschner SH, Lane CS. Recurrent fracture of the humerus in a softball

player. Am J Orthop (Belle Mead NJ). 1999;28(11):654–6. [PubMed:


2. Bingham EL. Fractures of the humerus from muscular violence. U S

Armed Forces Med J. 1959;10(1):22–5. [PubMed: 13625441].

3. Chao SL, Miller M, Teng SW. A mechanism of spiral fracture of the

humerus: a report of 129 cases following the throwing of hand

grenades. J Trauma. 1971;11(7):602–5. [PubMed: 5555684].

4. DevasMB.Stress Fractures in Children. J Bone Joint Surg Br. 1963;45:528–

41. [PubMed: 14058330].

5. DiCicco JD, Mehlman CT, Urse JS. Fracture of the shaft of the humerus

secondary to muscular violence. J Orthop Trauma. 1993;7(1):90–3.

[PubMed: 8433208].

6. Evans PA, Farnell RD, Moalypour S, McKeever JA. Thrower’s fracture: a

comparison of two presentations of a rare fracture. J Accid Emerg Med.

1995;12(3):222–4. [PubMed: 8581257].

7. Gregersen HN. Fractures of the humerus from muscular violence.

Acta Orthop Scand. 1971;42(6):506–12. [PubMed: 5144200].

8. Kaplan H, Kiral A, Kuskucu M, Arpacioglu MO, Sarioglu A, Rodop O.

Report of eight cases of humeral fracture following the throwing of

hand grenades. Arch Orthop Trauma Surg. 1998;117(1-2):50–2. [PubMed:


9. Ogawa K, Yoshida A. Throwing fracture of the humeral shaft. An

analysis of 90 patients. Am J Sports Med. 1998;26(2):242–6. [PubMed:


10. Reed WJ, Mueller RW. Spiral fracture of the humerus in a ball thrower.

Am J Emerg Med. 1998;16(3):306–8. [PubMed: 9596440].

11. Sabick MB, Torry MR, Kim YK, Hawkins RJ. Humeral torque in professional

baseball pitchers. Am J Sports Med. 2004;32(4):892–8. [PubMed:


12. Santavirta S, Kiviluoto O. Transverse fracture of the humerus in a

shotputter: a case report. Am J Sports Med. 1977;5(3):122–3. [PubMed:


13. NADA . Official Rules Chicago: National Amateur Dodgeball Association;

2007. [updated 2015]. Available from: http://www.dodgeballusa.


14. IDA . Official dodgeball rules Vancouver: International Dodgeball Assocation;

2013. [updated 2015]. Available from: http://playdodgeball.


15. NDL . US: National Dodgeball League; 2013. Available from: http://

16. MLB . US: Major League Baseball; 2013. Available from:


17. Wang Z, Sakurai S, Shimizu T. Kinetics Of Dodgeball Throwing With

An Implication About Injury Mechanisms Of Elbow Joint. 1. Michigan:

International Conference on Biomechanics in Sports; 2010.

18. Fleisig GS, Barrentine SW, Escamilla RF, Andrews JR. Biomechanics

of overhand throwing with implications for injuries. Sports Med.

1996;21(6):421–37. [PubMed: 8784962].

19. Dillman CJ, Fleisig GS, Andrews JR. Biomechanics of pitching with

emphasis upon shoulder kinematics. J Orthop Sports Phys Ther.

1993;18(2):402–8. doi: 10.2519/jospt.1993.18.2.402. [PubMed: 8364594].

20. Feltner M,DapenaJ.Dynamicsof the ShoulderandElbowJoints of the

Throwing Arm During a Baseball Pitch. J Appl Biomech. 1986;4(2):235–


21. Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching.

A preliminary report.AmJ Sports Med. 1985;13(4):216–22. [PubMed:


22. Glousman R, Jobe F, Tibone J, Moynes D, Antonelli D, Perry J. Dynamic

electromyographic analysis of the throwing shoulder with glenohumeral

instability. J Bone Joint Surg Am. 1988;70(2):220–6. [PubMed:


23. Gowan ID, Jobe FW, Tibone JE, Perry J, Moynes DR. A comparative

electromyographic analysis of the shoulder during pitching. Professional

versus amateur pitchers. Am J Sports Med. 1987;15(6):586–90.

[PubMed: 3425786].

24. Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbowduring

baseball pitching. J Orthop Sports Phys Ther. 1993;17(6):274–

8. doi: 10.2519/jospt.1993.17.6.274. [PubMed: 8343786].

25. Schopfer A, Hearn TC, Malisano L, Powell JN, Kellam JF. Comparison

of torsional strength of humeral intramedullary nailing: a cadaveric

study. J Orthop Trauma. 1994;8(5):414–21. [PubMed: 7996325].

26. Hershman EB, Mailly T. Stress fractures. Clin Sports Med. 1990;9(1):183–

214. [PubMed: 2404618].

27. Sprenger TR. Fracture of humerus from muscular violence: case report.

J Fla Med Assoc. 1985;72(2):101–3. [PubMed: 4056714].

28. Tullos HS, Erwin WD,Woods GW,Wukasch DC, Cooley DA, King JW. Unusual

lesions of the pitching arm. Clin Orthop Relat Res. 1972;88:169–82.

[PubMed: 5086567].

29. Jones HH, Priest JD, Hayes WC, Tichenor CC, Nagel DA. Humeral hypertrophy

in response to exercise. J Bone Joint Surg Am. 1977;59(2):204–8.

[PubMed: 845205].

30. Sakai K, Kiriyama Y, Kimura H, Nakamichi N, Nakamura T, Ikegami H,

et al. Computer simulation of humeral shaft fracture in throwing. J

Shoulder Elbow Surg. 2010;19(1):86–90. doi: 10.1016/j.jse.2009.05.006.

[PubMed: 19574067].

31. Brukner P. Stress fractures of the upper limb. Sports Med.

1998;26(6):415–24. [PubMed: 9885097].

32. Peltokallio P, Peltokallio V, Vaalasti T. Fractures of the humerus from

muscular voilence in sport. J Sports Med Phys Fitness. 1968;8(1):21–5.

[PubMed: 5657942].

33. Colapinto MN, Schemitsch EH, Wu L. Ball-thrower’s fracture of the

humerus. CMAJ. 2006;175(1):31. doi: 10.1503/cmaj.060378. [PubMed:


34. Kim SJ, Lee SH, Son H, Lee BG. Surgical result of plate osteosynthesis

using a locking plate system through an anterior humeral approach

for distal shaft fracture of the humerus that occurred during a throwing

motion. Int Orthop. 2016;40(7):1489–94. doi: 10.1007/s00264-015-

2895-3. [PubMed: 26202018].