Understanding humerus fracture and its treatment

Introduction

The humerus, the long bone in the upper arm, is a crucial component of the skeletal system. However, like any other bone, it is susceptible to fractures due to trauma or excessive stress. Humerus fractures can vary in severity and location, requiring different approaches to treatment. In this blog, we will get to know the intricacies of humerus fractures, exploring their types, causes, symptoms, diagnosis, and most importantly, treatment options.

What is Humerus Fracture ?

A humerus fracture refers to a break or crack in the humerus bone. These fractures can occur at various locations along the bone, including the proximal end, shaft, or distal end. Proximal humerus fractures, which occur near the shoulder joint, are the most common type, followed by fractures of the humeral shaft and distal humerus fractures.

Humerus Fracture Types

• Proximal Humerus Fracture: Proximal humerus fractures involve the upper portion of the humerus bone near the shoulder joint. These fractures often result from falls onto an outstretched arm or direct trauma to the shoulder region. They are more prevalent in older adults due to age-related bone weakening (osteoporosis). Proximal humerus fractures can be further classified based on the number and pattern of fracture fragments. Common types include two-part, three-part, and four-part fractures.
• Humerus Shaft Fracture: Humerus shaft fractures occur in the middle portion of the humerus bone. They can result from direct blows or high-energy trauma such as motor vehicle accidents. Humerus shaft fractures are less common but may cause significant pain and functional impairment. Depending on the severity of the fracture, they can be transverse, oblique, or spiral in nature.
• Distal Humerus Fracture: Distal humerus fractures occur near the elbow joint, involving the lower end of the humerus bone. These fractures are often the result of a fall onto an outstretched hand or a direct impact to the elbow region. Distal humerus fractures can be intra-articular or extra-articular, depending on whether they involve the joint surface. Intra-articular fractures are more complex and may require meticulous surgical management.

Causes and Risk Factors

Humerus fractures can occur due to various factors, including:

• Trauma: Falls, sports injuries, and motor vehicle accidents can all lead to humerus fractures. High-impact activities such as skiing, cycling, and contact sports increase the risk of traumatic fractures.
• Osteoporosis: Weakening of the bones due to osteoporosis increases the risk of fractures, particularly in older adults. Individuals with osteoporosis have lower bone density, making their bones more susceptible to fractures even with minimal trauma.
• Repetitive Stress: Overuse or repetitive stress on the arm can lead to stress fractures in the humerus bone. This is commonly seen in athletes who engage in repetitive overhead movements, such as baseball pitchers and tennis players.

Symptoms Of Humerus Fracture:

The symptoms of a humerus fracture may vary depending on the location and severity of the injury. Common symptoms include:

• Pain, swelling, and bruising around the injured area.
• Difficulty moving the arm or performing daily activities.
• Visible deformity or abnormal positioning of the arm.

• Numbness or tingling sensation in the arm or hand.

• In some cases, the presence of an open wound or the bone protruding through the skin (open fracture) may be evident.

Diagnosis Of Humerus Fracture:

Diagnosing a humerus fracture typically involves a combination of physical examination, imaging tests, and medical history review. During the physical examination, the healthcare provider will assess the injured arm for signs of tenderness, swelling, deformity, and range of motion. Imaging studies, such as X-rays, are commonly used to visualise the extent and location of the fracture. X-rays provide detailed images of the bone, allowing healthcare providers to determine the type of fracture and develop an appropriate treatment plan. In some cases, additional imaging studies such as computed tomography (CT) scans or magnetic resonance imaging (MRI) may be necessary to assess complex fractures or soft tissue damage.

Humerus Fracture Treatment:

The treatment approach for a humerus fracture depends on several factors, including the type of fracture, its location, and the patient’s overall health. Treatment options may include:

• Conservative Management: Non-displaced or minimally displaced fractures may be treated conservatively with immobilisation using a sling or brace, pain management, and physical therapy to restore mobility and strength. This approach is often suitable for stable fractures without significant displacement or involvement of the joint surface.
• Closed Reduction and Immobilization: For displaced fractures, a procedure called closed reduction may be performed to realign the bones followed by immobilisation with a cast or splint to promote healing. Closed reduction entails realigning the broken bone fragments to their proper position without resorting to surgical intervention.
• Immobilisation helps stabilise the fracture and prevent further displacement during the healing process.
• Surgical Intervention: Complex or unstable fractures may require surgical intervention to realign the bone fragments and stabilise the fracture. Common surgical procedures for humerus fractures include open reduction and internal fixation (ORIF), where the bones are realigned and secured with screws, plates, or rods, and external fixation, which involves stabilising the fracture with pins placed outside the body. The choice of surgical technique depends on the specific characteristics of the fracture and the surgeon’s preference. In cases of severe comminution or bone loss, bone grafting may be necessary to promote bone healing and restore stability.
• Rehabilitation: Regardless of the treatment approach, rehabilitation plays a crucial role in the recovery process. Physical therapy exercises are essential for restoring range of motion, strength, and function in the affected arm. The rehabilitation program typically begins soon after the fracture is stabilised and continues throughout the healing process. The physical therapist will tailor the exercises to the individual’s specific needs and gradually progress the intensity as the fracture heals. In addition to exercises, other rehabilitation techniques such as manual therapy, modalities (e.g., ultrasound, electrical stimulation), and functional training may be incorporated to optimise outcomes.

Recovery and Prognosis:

The recovery period for a humerus fracture varies depending on the severity of the injury, the effectiveness of treatment, and individual factors such as age and overall health. In general, minor fractures may heal within a few weeks with conservative treatment, while more severe fractures or those requiring surgery may take several months to heal completely. Following the prescribed treatment plan, attending physical therapy sessions, and practising proper self-care can help expedite recovery and improve outcomes. During the recovery period, it is essential to follow any restrictions on activity and avoid putting undue stress on the healing bone. Gradual return to normal activities should be guided by the healthcare provider and physical therapist to minimise the risk of reinjury.

Complications:

While most humerus fractures heal without complications, certain factors may increase the risk of complications or delayed healing. These include:

• Infection: Surgical procedures carry a risk of infection, which can delay healing and necessitate additional treatment such as antibiotics or surgical debridement.
• Malunion or Nonunion: Improper alignment of the bone fragments (malunion) or failure of the fracture to heal (nonunion) may occur in some cases, particularly with complex fractures or inadequate treatment. Revision surgery may be necessary to correct malunion or promote healing in cases of nonunion.
• Nerve or Blood Vessel Injury: Severe fractures or surgical interventions near the shoulder or elbow joint may pose a risk of injury to nearby nerves or blood vessels, leading to sensory or motor deficits, or vascular compromise. Close monitoring and timely intervention are essential to minimise the risk of permanent damage.

Conclusion:

In conclusion, humerus fractures are significant orthopaedic injuries that require prompt diagnosis and effective treatment for optimal recovery. Whether treated conservatively or surgically, the goal is to restore function and minimise complications, enabling patients to regain mobility and resume normal activities. Under the expert guidance of orthopaedic surgeon Dr. Hardik Padhiyar, known for his patient-centric approach and expertise in trauma management, individuals with humerus fractures can expect comprehensive care and favourable outcomes. Seeking timely medical attention and adhering to the prescribed treatment and rehabilitation plan are crucial steps toward achieving full recovery and returning to a fulfilling lifestyle.