A fractured humerus or upper arm is extremely painful, and the patient may not be able to move their arm. Sometimes, the radial nerve (one of the main nerves in the arm) may be injured. This happens about 15% of the time. It is more common with fractures that happen closer to the base of the bone. If this nerve is injured, the patient may not be able to extend his wrist, fingers, or thumb, and may have a numb patch on the back of his hand.
- The diagnosis is made using a clinical examination and X-rays.
- After the fracture is diagnosed, the patient will likely be placed into a splint or a cast that supports the bone until a final treatment plan is made with an orthopedic surgeon. If the pain is controlled and no serious injuries are present, admission to the hospital is typically not necessary.
- Many isolated humeral shaft fractures (assuming you do not have any other injuries) can be treated without surgery, even if the radial nerve is injured. The treatment is done with a cast.
- For the patient, the orthopedic surgeon may switch from a splint (cast) to an adjustable brace at around 1-3 weeks after the injury. This brace is typically worn full time for at least 6 weeks and possibly up to 12 weeks.
- Once the fracture is healing well, the patient may be allowed to wear the braceless, often over a period. Generally, physical therapy is helpful to regain strength and range of motion during this period.
- There are times when the orthopedic surgeon may choose to perform surgery. For example, if the bone comes through the skin (open fracture) or if the patient has multiple other fractures or injuries.
- If surgery is chosen, this will be performed through an incision or cut on either the front or the back of your arm, depending on the location of your fracture.
- The fracture will most likely be treated with a plate and screws on the bone or occasionally, with a rod that goes down the middle of the bone.
- If the fracture is treated with surgery, a brace is fitted as per requirement. This is done at the discretion of the surgeon. Physical therapy is often prescribed to help improve motion and strength after surgery. The patient may still have considerable pain in the arm, but this typically declines over several weeks.
- The patient may have to follow up with the surgeon or their staff several times over the next few months during the healing process.
- Occasionally, a fracture will not heal or will heal in an undesirable position. If this occurs, another surgery may be necessary.
- If the fracture was associated with an injury to your radial nerve, there is a good chance that the nerve will recover completely. Most of the time the nerve is just bruised, and it heals itself after some time. This process can be slow; sometimes, it may take up to 6-12 months. Occasionally, the nerve will not heal, and a nerve study can be performed to evaluate the nerve. On rare occasions, additional procedures are necessary to restore the function of the nerve.
What is a humerus fracture?
The humerus is the upper arm bone situated between the elbow and the shoulder. Humerus fractures account for a remarkably small proportion of total bone fractures. The causes may include:
- A direct blow or bending force applied to the middle of the humerus
- Falling onto an outstretched arm
- Violent muscle contraction in sports, such as weightlifting
Accident or severe injury is the main cause of humerus fractures. Most injuries result from a direct impact to the body, such as during a fall or motor vehicle crash. Older adults may experience humerus fractures from relatively minor falls due to less bone strength and bone degradation.
Signs and symptoms:
- Patients usually present with considerable pain and swelling following a humeral fracture. Shortening of the arm is apparent with significant displacement of the bones.
- It may be very difficult for an individual to move their upper arm.
- If the nerves are also affected, they may experience unusual sensations and weakness in the hand and wrist.
- A grinding sensation when the shoulder is moved
- Occasionally bleeding (open fracture)
Different types of humerus fractures include:
- Proximal humerus fractures occur near the shoulder.
- Midshaft fractures are located in the middle of the bone.
- Distal humerus fractures are located near the elbow joint and are more common in children than in adults.
The doctor may diagnose a fractured humerus by:
- Examining the arm
- Taking an X-ray of the affected arm
- In rare cases, more sophisticated imagery, such as a computed tomography (CT) scan is used to provide a more detailed view.
The recovery process is different for everyone, depending on the severity of the injury and the treatment you received. Most fractures heal in about 4 to 6 weeks, but severe injuries may take longer to heal.
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University Orthopaedics. Humerus fracture. http://www.uopc.org/trauma/humerus-fracture/
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