Humerus fractures

Background

 

The humerus (upper arm bone) can break (fracture) following a fall or from a direct impact. The vast majority of these fractures heal without the need for surgery. The position of the break on the bone partly contributes to whether you may be advised to have surgery or not, together with the amount it may be displaced. Most humerus fractures are proximal humerus fractures, those which occur near the shoulder joint, but the bone can also break in the middle of the bone (mid-shaft humerus fractures), or near the elbow (distal humerus fractures). In some cases, more commonly where the bones have been left to heal without surgery, the bones may not heal (non-union) or may heal in an incorrect position (mal-union). Mal-unions may not cause symptoms, but some people find that if the bone heals in an abnormal position they can experience problems with certain activities. If you are having symptoms then you may be advised to have surgery to correct the position of the bones or try and make them heal together.

The main risk factor for bones not healing is smoking (including vaping nicotine).

     

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Acute humerus fractures

 

Causes

A humerus fracture usually occurs from a fall onto your outstretched hand or from a direct impact to the arm.

 

Symptoms

Pain with bruising and swelling are the usual symptoms. Swelling of the hand is also common and the bruising can settle along your forearm as gravity draws the blood from the fracture site downwards.

 

Treatment - non-surgical

The treatment of acute (new) humerus fractures is usually a sling or brace together with adequate painkillers. It is important to remove any jewelry from your hand and wrist, as they will swell. Stopping smoking if you are a smoker will also help the bone to heal faster and reduce the possibility that it will not heal.

 

Treatment - surgical

For some acute fractures, surgery may be advised in order to realign the bones as close to how they were before they broke. Surgery may also be advised it the fracture is associated with other injuries around the shoulder including breaks in the skin or where the fracture involves the joint either at the shoulder or the elbow.

Surgery aims to correct the fracture to its original length and position and align the joint surfaces of any involved joint. It also provides initial pain relief through stability and gives a higher rate of successful healing (lower non-union rate). In some cases if it is not possible to fix the fracture, particularly in older people with softer bones, then the shoulder or elbow may be replaced. This is something that you can discuss with your surgeon.

 

Physiotherapy / rehabilitation after surgery

After surgery you will be in a sling but will be able to take your arm out to perform the physiotherapy exercises advised.

You will usually be able to get back to work at a couple of weeks and do light two-handed activities at 3 weeks from surgery. Strengthening work will not usually commence until about 3 months from surgery.

 

Outcome

The outcome depends on the nature of the fracture and whether it successfully heals. If the fracture involved the joint then you can have an increased risk of arthritis and problems with the joint in the future. On the whole, even if the bone is not aligned perfectly, because of the large range of movement possible in the shoulder, your function is not usually significantly affected. However, the shoulder and elbow can become stiff, particularly if you have been in a sling for a long period. While the stiffness may improve with time, sometimes people have a persistent reduced movement in the shoulder or elbow.

 

 

Humerus fracture non-unions and mal-unions

 

Causes

A humerus fracture usually occurs from a fall onto your outstretched hand or from a direct impact to the arm. If the bones are not aligned well then they can heal in a mal-united position. In some cases if there is soft tissue in the way of the fracture, or if you are a smoker, the bones may not heal together.

 

Symptoms

In cases of mal-union there may be an aching in the shoulder or arm and a sense that your shoulder is not quite right. You may have pain or a restriction in lifting your arm, or with certain sports.

For non-unions there may be ongoing pain and the bones may be felt to move. If the break is in the middle of the bone and it has not healed, the bone may become prominent as you try and lift your arm, making the arm weak.

 

Treatment - non-surgical

If you have a non-union or mal-union your fracture will usually have been treated without surgery. If you have ongoing problems the option is to carry on as you are and adjust your activities to avoid symptoms, or to consider surgery.

 

Treatment - surgical

For non-unions or mal-unions, the operation is similar to fixing a new fracture, although because the bone has tried to heal and scar tissue is present it is a bigger operation with greater risks. The aim is to get the bone re-aligned and healed. You may also need some bone graft to promote the fracture healing. This is usually taken from your iliac crest (hip area) on the same side as your humerus fracture.

In some cases, rather than fixing the fracture, replacing the shoulder or elbow joint may be advised. This often gets you moving quicker but will only be advised if it is considered that the fracture is too severe to be able to be fixed successfully.

If you are a smoker it is important to stop before surgery as smoking (and vaping nicotine) substantially increases the risk of the bones not healing.

 

Physiotherapy / rehabilitation after surgery

After surgery you will usually be in a sling but will be able to take your arm out to perform the physiotherapy exercises advised.

You will usually be able to get back to work at a couple of weeks and do light two-handed activities at 6 weeks from surgery. Strengthening work will not commence until around 3 months from surgery.

 

Outcome

The outcome depends on the nature of the mal-union or non-union, and whether it successfully heals following surgery. On the whole, patients usually report an improvement following mal-union surgery, although some symptoms may persist. In terms of non-union surgery, if the humerus heals successfully then the instability at the fracture site and any associated pain should resolve. The shoulder and elbow can however become stiff, particularly if you have been in a sling for a long period. While the stiffness may improve with time, sometimes people have a persistent reduced movement in the shoulder or elbow.

 

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