Humerus fracture

Closed shaft fracture in the middle of humerus

After a humerus fracture, pain is immediate, enduring, and exacerbated with the slightest movements. The affected region swells, with bruising appearing a day or two after the fracture. The fracture is typically accompanied by a discoloration of the skin at the site of the fracture.[3][4] A crackling or rattling sound may also be present, caused by the fractured humerus pressing against itself.[5] In cases in which the nerves are affected, then there will be a loss of control or sensation in the arm below the fracture.[6][4] If the fracture affects the blood supply, then the patient will have a diminished pulse at the wrist.[6] Displaced fractures of the humerus shaft will often cause deformity and a shortening of the length of the upper arm.[5] Distal fractures may also cause deformity, and they typically limit the ability to flex the elbow.[7]

Humerus fractures usually occur after physical trauma, falls, excess physical stress, or pathological conditions. Falls that produce humerus fractures among the elderly are usually accompanied by a preexisting risk factor for bone fracture, such as osteoporosis, a low bone density, or vitamin B deficiency.[8]

Definitive diagnosis of humerus fractures is typically made through radiographic imaging. For proximal fractures, X-rays can be taken from a scapular anteroposterior (AP) view, which takes an image of the front of the shoulder region from an angle, a scapular Y view, which takes an image of the back of the shoulder region from an angle, and an axillar lateral view, which has the patient lie on his or her back, lift the bottom half of the arm up to the side, and have an image taken of the axilla region underneath the shoulder.[9] Fractures of the humerus shaft are usually correctly identified with radiographic images taken from the AP and lateral viewpoints.[12] Damage to the radial nerve from a shaft fracture can be identified by an inability to bend the hand backwards or by decreased sensation in the back of the hand.[5] Images of the distal region are often of poor quality due to the patient being unable to extend the elbow because of pain. If a severe distal fracture is suspected, then a computed tomography (CT) scan can provide greater detail of the fracture. Nondisplaced distal fractures may not be directly visible; they may only be visible due to fat being displaced because of internal bleeding in the elbow.[7]

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  A fracture of the greater tuberosity as seen on AP X ray
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  A fracture of the greater tuberosity of the humerus
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  Fracture of the greater tuberosity of the humerus
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  Multi-fragmented, or comminuted fracture of the proximal humerus with involvement of the greater tuberosity
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  Proximal humerus fracture
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  A transverse fracture of the humerus shaft
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  A spiral fracture of the distal one-third of the humerus shaft
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  A displaced supracondylar fracture in a child

The aim of treatment is to minimize pain and to restore as much normal function as possible. Most humerus fractures do not require surgical intervention.[4]

In most cases, people are discharged from an emergency department with pain medicine and a cast or sling. These fractures are typically minor and heal over the course of a few weeks.[4] Fractures of the proximal region, especially among elderly people, may limit future shoulder activity.[19][20] Severe fractures are usually resolved with surgical intervention, followed by a period of healing using a cast or sling.[11] Severe fractures often cause long-term loss of physical ability.[21] Complications in the recovery process of severe fractures include osteonecrosis, malunion or nonunion of the fracture, stiffness, and rotator cuff dysfunction, which require additional intervention in order for the patient to fully recover.[21]

Humerus fractures are among the most common of fractures. Proximal fractures make up 5% of all fractures and 25% of humerus fractures,[9] middle fractures about 60% of humerus fractures (12% of all fractures),[12] and distal fractures the remainder. Among proximal fractures, 80% are one-part, 10% are two-part, and the remaining 10% are three- and four-part.[22] The most common location of proximal fractures is at the surgical neck of the humerus.[3] Incidence of proximal fractures increases with age, with about 75% of cases occurring among people over the age of 60.[11] In this age group, about three times as many women than men experience a proximal fracture.[23] Middle fractures are also common among the elderly, but they frequently occur among physically active young adult men[24] who experience physical trauma to the humerus.[12] Distal fractures are rare among adults, occurring primarily in children who experience physical trauma to the elbow region.[7]