Humerus Bone Fracture
Humerus bone fracture or broken humerus bone is a quite serious injury with absolutely nothing humorous about it. This fracture is associated with several complications and can have disastrous outcomes if not properly managed. A fall on the elbow or the arm can be sufficient to cause a humerus fracture in an elderly individual. It is also seen in younger individuals after road accidents or fall from a height or direct injury to the arm at work. Sometimes it is also seen along with dislocation of the elbow or shoulder joint, in which case the fracture is generally not very severe.
Humerus Bone Anatomy
The humerus is a long stout arm bone, which extends from the shoulder to the elbow. Humerus anatomy is mainly related to the upper end, shaft and lower end. The upper end forming the shoulder joint is rounded and articulates with the glenoid cavity. The lower end is irregular in shape due to a multitude of movements, which it supports, like elbow bending (flexion), rotation (pronation & supination) for turning keys etc. The lower end, also called the humeral condyle, articulates with the radius bone as well as the ulna bone to form the elbow joint. Several important muscles of the arm either originate or attach on the humerus bone shaft, like brachalis, triceps, and so on, which provide movements at the elbow and shoulder joint.
Humerus Bone Fracture Types
Due to the long length of the humerus bone and several functions sub-served, it can be injured at multiple locations, with consequences depending greatly on the exact location of the fracture. Another important determinant is the displacement of the bone fracture fragments, with undisplaced fractures being least severe and displaced fractures having worst outcome.
- Proximal humerus fracture is generally due to fall on the shoulder and may be accompanied with shoulder dislocation. This is a common injury in elderly females even after trivial falls due to post menopausal osteoporosis. Due to the cancellous (spongy) nature of the humerus bone in this part, there can be collapse and deformation of the bone along with fracture, which requires correction at the time of treatment.
- Midshaft humerus fracture is mostly after a fall on the elbow or road accidents. The radial nerve passes very close to this part of humerus bone and can be injured either due to primary trauma, or due to being trapped between fractured bone ends, or even during treatment manipulations. Hence, care should be exercised at each step to ensure the integrity of the radial nerve and even the slightest suspicion of any radial nerve palsy should be followed by an exploratory surgery.
- Distal humerus fracture can be either supracondylar humerus fracture or condylar humerus fracture. A supracondylar humerus fracture is at the junction of the condyle (lower end) and the shaft, and is the commonest elbow fracture in children. A condylar fracture is a severe humerus fracture and is generally due to high velocity injuries, like car accidents or falls from a height. They frequently result in an unstable elbow even after surgery and frequently necessitate an elbow replacement surgery for regaining elbow function.
Humerus Bone Fracture Pictures
Picture 1: Midshaft Humerus Fracture
Picture 2: Distal Humerus Fracture
Picture 3: Proximal Humerus Fracture
Humerus Bone Fracture Symptoms
A fractured humerus bone tends to remain in place due to the gravitational force on the overhanging forearm maintaining the alignment. However, the supportive function of the arm bone is severely compromised, causing severe bone pain on attempted movements at shoulder or elbow joint. Swelling, bruising, and tenderness can be noted as early as 2-3 hours after injury. In presence of humerus fracture with radial nerve injury, a person is unable to lift up the wrist (wrist drop), as in while accelerating a scooter. A medical test for radial nerve palsy is the inability to do the thumbs up sign popular in hitchhiking (hitchhikers sign).
Picture 4: Thumbs up sign
Humerus Fracture Treatment
Primary concern about humerus bone fracture is related to prevention of radial nerve injury. This can be well avoided by keeping a high grade of suspicion for it and early stabilization of the humerus fracture. A hanging cast, though a bit uncomfortable, but is highly suited for this purpose.
Picture 5: Humerus fracture brace
A humerus fracture brace should generally be reserved for surgical cases, where a hanging cast can be obstructive to the wound dressing. Minor fractures like an undisplaced proximal humerus fracture, would require nothing but just a shoulder immobilization.
Humerus Bone Fracture Video
This humerus fracture video is depicting the typical senario in an ER of a hospital, and the injured person is being given a hanging cast for stabilization of the humerus fracture.
Humerus Fracture Surgery
Displaced fractures of the humerus are well managed with humerus fracture surgery. The surgery involves relocation of the displaced bone and securing it by using orthopedic screws and plates. For midshaft humerus fractures a surgery may even be a cause of radial nerve injury and hence, one should carefully note the presence or absence of radial nerve injury before and after a humerus fracture surgery. The surgery for condylar humerus fracture is highly complicated due to the location of the fracture within the elbow joint. However, if properly performed it can prevent the need for an expensive elbow replacement surgery in the future.
Humerus Fracture Recovery
Humerus fracture recovery is based on several factors, like
- Severity of Humerus Fracture and soft tissue injury.
- Number and displacement of bone fragments.
- Associated Radial Nerve injury.
- Time delay between injury and treatment
- Humerus fracture rehabilitation exercises
A complete humerus fracture recovery may take around 3-4 months, which includes a couple of months for humerus fracture healing followed by the use of protective humerus fracture brace for a couple of months for support and humerus fracture rehabilitation exercises.