Johns Hopkins Orthopaedic Surgery
Division of Trauma Surgery
Humerus Fractures (Upper Arm)
Proximal Humerus Fracture
Humerus Shaft Fracture
What is a Proximal Humeral Fracture?
The humerus (upper arm bone) is a long bone that runs from the shoulder and scapula to the elbow. A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns: simple or comminuted fracture.
Symptoms of fractures about the shoulder are related to the specific type of fracture.
- Swelling and bruising
- Inability to move the shoulder
- A grinding sensation when the shoulder is moved
- Deformity -- "It does not look right"
What is the treatment for a Proximal Humerus Fracture?
Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). If the fragments are shifted out of position, surgery is usually required. However, other factors are also considered in the deciding surgical fixation or non surgery.
Non operative treatment is usually with a sling or shoulder immobilizer with no shoulder mobility for the first 2 weeks. Thereafter the patient will receive specific weekly exercises to slowly increase the range of motion. An X-ray of the shoulder will be taken in a weekly-biweekly basis to assure proper healing.
Surgery usually involves fixation of the fracture fragments with plates, screws, or pins or in severe fractures with previous arthropathy (joint degeneration) may require shoulder replacement.
Humerus Shaft Fracture
This is a fracture localized at the mid portion of the upper arm. A broken arm is a common injury, and is usually a consequence of a fall with an outstretched hand or being in a car crash or some other type of accident.
Symptoms of fractures of the humerus shaft are:
- Visible deformity with swelling
- Occasionally bleeding (open fracture)
- Loss of normal use of the arm if a nerve injury occurs
What is the treatment for Humerus Shaft Fracture?
A humerus shaft fracture can be treated with or without surgery, according to the fracture pattern and associated injuries (.i.e nerve injury or open fracture).
A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be the initial management.
Non operative treatment is usually fracture bracing that will be changed after 3-4 weeks to a cylindrical brace (Sarmiento Brace) that will fit the upper arm leaving the elbow free. The doctor will tell you how long to wear the cast or splint and will remove it at the right time. It may take from several weeks to several months for the broken arm to heal completely.
Rehabilitation involves gradually increasing activities to restore muscle strength, joint motion and flexibility. The patient's cooperation is essential to the rehabilitation process. The patient must practice daily complete range of motion, strengthening and other exercises prescribed by the doctor. Rehabilitation continues until the muscles, ligaments, and other soft tissues perform
Surgery usually involves internal fixation of the fragments with plates, screws or a nail. The rehabilitation alters slightly from the non operative treatment, with no splints or cast. The patient is usually given a sling for comfort and arm support. Elbow exercises may be start immediately after surgery, while shoulder exercises may be delayed for a few weeks.