Humerus fracture: Types, causes, treatments, and recovery tips

By: Dr. Victor Marchione | Bone Health | Thursday, March 02, 2017 - 05:30 AM

Humerus fractureA fractured humerus is a relatively common injury, especially among the elderly and those with osteoporosis. The humerus is located in the upper arm and is usually fractured due to a fall or direct trauma, though approximately eight percent of humerus fractures have been found to be pathological—meaning it is caused by disease such as Paget’s disease of the bone—especially in older adults. Continue reading to learn about the different types of humerus fractures, what causes them, how they are treated, and how long they take to heal.

Humerus fracture types

There are three main types of humerus fractures that are classified based on where the bone has broken. These types of fractures are:

Proximal humerus fractures (Broken upper arm)

A proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. It is the third most common fracture that occurs in individuals over the age of 65, after hip and wrist fractures. A proximal humerus fracture occurs when the ball of the ball and socket joint in the shoulder is broken, meaning the break is actually located at the top of the humerus—or arm bone. Many who experience this type of fracture will not regain full mobility of the affected shoulder, even if the injury is treated correctly.

Distal humerus fractures

A distal humerus fracture affects the elbow and is a break in the lower end of the humerus. These types of humerus fractures are most often caused by direct trauma and is commonly sustained in car accidents. However, they may also occur due to falls in the elderly. Surgery is usually needed to restore the structure and function to the elbow after a distal humerus fracture.

Mid-shaft humerus fractures

A mid-shaft humerus fracture occurs in the middle of the humerus bone and usually does not involve the shoulder or elbow joints. These fractures can be caused by car accidents, sports injuries, and even gunshot wounds, though in the elderly they are most often the result of a fall. In most cases, these injuries are able to heal correctly without surgery.

Proximal, midshaft, and distal humerus fracture: Causes and symptoms

Humerus fractures are often the result of a fall or direct blow to the arm. If you fall and catch yourself with an outstretched arm, your locked elbow may cause a distal humerus fracture. Similarly, falling directly on the elbow, shoulder, or any part of the humerus may result in a fracture. Humerus fractures also occur when a direct blow is taken to the arm, which may occur as a sports injury or car accident injury.

A humerus fracture is often accompanied by symptoms such as swelling, bruising, stiffness, the feeling of joint instability, and tenderness in the affected area. In some cases, the bone may protrude through the skin in what is known as an open fracture.

Complications of humerus fractures

In most cases, the mobility will return to the joint after the fracture heals, although in some cases complications may arise. These complications include:

Nonunion. When the bone does not heal, it is referred to as nonunion. Treatment must address the underlying issue, as there are various reasons this may occur, the most common being that the patient is a smoker.

Malunion. When the bone heals but does so improperly, it is known as malunion. This can occur if the bone is not properly immobilized during the healing process, resulting in a misalignment.

Nerve injury. The nerves in the arm are positioned near the humerus bone and may become injured when a fracture occurs. Specifically, the radial nerve is often damaged when the humerus is fractured and causes numbness and tingling in the back of the hand. This damage normally recovers over the course of a few months.

Joint stiffness. Stiffness in the shoulder or elbow is common after a proximal humerus fracture and a distal humerus fracture respectively. You may not regain your full range of motion in these joints and they may also feel weaker.

Diagnosis of humerus fractures

To diagnose whether you have sustained a humerus fracture, your doctor will first perform a physical exam and check for swelling and tenderness throughout the upper arm, elbow, and shoulder. They may also ask you to move your fingers and wrist and examine your arm for signs of bone protrusions. Your doctor could also order an x-ray to determine the exact location of the fracture, as well as its severity.

Humerus fracture treatment tips

In most cases, treating a humerus fracture does not require surgery as the bone is often not out of place. Casting is usually not an option for most humerus fractures, so your doctor will recommend you keep your arm in a sling or brace in order to minimize movement and allow it to heal properly. Surgery may be necessary if fragments of the bone are far out of position in order to prevent a malunion.

Humerus fracture recovery tips

To aid in the recovery of your fracture, you may need to ice the injury, keep it elevated, or take painkillers (either over-the-counter or prescription depending on the severity of your pain) in order to help you manage any pain. Rehabilitation will be necessary whether you have undergone surgery or not in order to restore motion to the joint affected. Nonsurgical treatments like splinting or using a sling may cause your elbow to become stiff, meaning you may require a longer period of physical therapy to help strengthen muscles, fight stiffness, and improve your range of motion.

If your fracture did require surgery, it is likely that you will also have to complete some form of physical therapy, beginning as early as the day after your operation. You may also be told to limit the use of the affected arm for approximately six to 12 weeks in order to give it time to heal without encouraging complications.

Preventing humerus fractures

While some accidents cannot be avoided, there are steps you can take to help reduce the risk of sustaining a humerus fracture. Build your bone strength by adding foods rich in calcium and vitamin D to your diet such as cheese, yogurt, and other dairy products. Also ensure that you exercise regularly to maintain proper posture and better balance as well as improve your muscle strength in order to prevent falls.

Reduce your risk of falling by wearing appropriate footwear for the weather, installing proper lighting in your living space, and clearing any clutter off the floor to prevent trips. Finally, wear protective gear when engaging in activities like contact sports or ones that require balance like skating and skiing.

Humerus fractures are breaks sustained to the upper arm that may affect your shoulder or elbow, depending on the type of fracture. They often do not require surgery to heal, though in some cases when the bone fragments become misaligned, surgery is necessary to correct their position and ensure proper healing.

In older adults, osteoporosis is most commonly the underlying cause as a fall can result in a fracture of weakened bones. Prevent these fractures by supplementing your diet with foods to aid in bone strength as well as by exercising regularly and taking precautions, like wearing sensible footwear and protecting your bones when engaging in risky activities.

Related: Osteoporosis fractures: Exercises and their benefits in reducing bone fracture risk


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Sources:

http://www.fxmendozamd.com/2016/03/causes-and-treatments-for-proximal-humerus-fractures/
http://orthoinfo.aaos.org/topic.cfm?topic=A00513
https://www.northwell.edu/find-care/services-we-offer/orthopaedic-institute/conditions/humerus-fracture#65986

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