What is a humerus fracture?
The humerus is the bone of the upper arm. A fracture or break in the humerus generally occurs secondary to trauma, commonly from a fall from a standing height, but in some cases with higher energy. These fractures can be simple 2 part fractures, but in some instances, the bone can fracture in multiple places. These breaks can either occur at the top of the humerus (proximal humerus fracture), in the middle (humeral shaft fracture) or at the bottom, near the elbow (distal humerus fracture).
What are the symptoms of a humerus fracture?
Patients develop immediate pain and swelling and there can be a visible deformity or prominence of the fracture end under the skin. There can be associated damage to the nerves and blood vessels. The patient will have limited use of the arm in the acute phase and continued pain and potentially poor function until the fracture heals.
How is it diagnosed?
It is diagnosed by taking a careful history and performing a detailed examination. There are also other associated injuries of the shoulder including scapula fractures which can occur with any trauma in this area. X-ray, and CT imaging in selected cases, can be useful to exclude other potential injuries and to further assess the fracture particularly in cases where surgical management is required. The investigations will help to inform the clinician and patient regarding the most appropriate treatment.
How is it treated?
Treatment begins with symptomatic management such as pain killers, with the use of a sling for support and in immobilising the fracture.
The displacement of the fracture and the location and the degree of associated trauma help to guide the patient and clinician with regards to the need for surgery. The demands of the patient both for their occupation and for sporting activities are a key component of making this decision.
The location of the fracture will guide this and the treatment options vary from sling management, humeral bracing, and surgery with either internal fixation with a plate, intramedullary nail or even shoulder or elbow replacement in some cases. Surgery can provide the patient with a more predictable and earlier return to work and sporting activities. When indicated It can lead to decreased pain, improved range of movement and function. Postoperative physiotherapy is essential to ensure the best outcome from surgery.
