A broken arm occurs when one of the three bones in the arm—the humerus, radius, or ulna—breaks or cracks. The time a patient spends in the hospital following this injury ranges from a few hours in the emergency department to several days of inpatient care. The length of stay is determined primarily by the fracture’s severity and the specific treatment method required to realign and stabilize the bone fragments.
Initial Assessment and Stabilization
Assessment begins immediately upon arrival in the emergency department with a rapid triage and physical examination. Clinicians first check for immediate threats to the limb, such as severe open wounds or signs of neurovascular compromise, which is damage to the nerves or blood vessels near the fracture site. This thorough assessment includes checking for swelling, deformity, and the presence of a distal pulse, along with testing motor and sensory function to evaluate nerve involvement.
Diagnostic imaging, typically involving X-rays, is then performed to determine the exact location and pattern of the fracture. These images classify the injury, revealing if the fracture is closed (skin intact) or open (bone pierces the skin), and whether it is stable or displaced. Initial pain management is also implemented promptly, often with intravenous medications, while the medical team prepares for the next step of treatment.
The immediate goal is to stabilize the limb and restore the bone fragments to a near-anatomical alignment, a procedure known as reduction. If the fracture is non-displaced or can be successfully realigned without surgery, a closed reduction is performed, often under sedation or regional anesthesia. If the fracture is highly unstable, involves multiple fragments (comminuted), or is open, the patient is prepared for an open reduction and internal fixation (ORIF). This determination between non-surgical immobilization and surgical intervention strongly influences the subsequent hospital stay.
Factors Determining Hospital Stay Duration
For simple or stable fractures treated with a closed reduction and immobilization in a cast or splint, the hospital stay is generally the shortest. These patients typically require only four to eight hours of monitoring after the reduction to ensure proper circulation and pain control before they are discharged home.
Complex, unstable, or open fractures that require surgical intervention significantly increase the time spent in the hospital. When an ORIF procedure is necessary, the stay duration is tied to the surgical schedule and the need for post-operative recovery. Patients undergoing surgery usually remain hospitalized for one to four days to manage pain, monitor the surgical site, and observe for early complications. For complex fractures, such as those involving the proximal humerus, the median length of stay after surgery has been reported around five days.
Patient-specific factors also play a substantial role in determining the hospitalization period. Elderly patients or those with pre-existing health conditions, known as comorbidities, often require a longer observation time due to an increased risk of complications. Additional medical diagnoses or significant injuries accompanying the fracture, such as a head injury or a vascular injury, also necessitate an extended stay to ensure overall patient stability.
Observation Period and Discharge Protocols
Following definitive treatment, whether casting or surgery, patients enter a mandatory observation period focused on complication prevention and stabilization before discharge. Close monitoring for acute compartment syndrome is a primary concern. Although most cases occur within the first 24 hours, vigilance is maintained because this syndrome can develop up to 65 hours after the initial trauma, particularly with high-energy injuries.
A major component of the pre-discharge phase is optimizing pain management by transitioning the patient from intravenous (IV) pain medications to a stable regimen of oral analgesics. This transition ensures the patient can manage pain effectively at home. Constipation is a common side effect of narcotic pain medications, so patients are often given stool softeners and advised on hydration to prevent this issue.
Patient and caregiver education is the final step before the hospital stay concludes, covering essential post-discharge care protocols. This education includes detailed instructions on:
- Wound care or cast care.
- Signs of potential infection or circulatory problems.
- How to properly use a sling or brace.
- Avoiding placing any weight or strain on the injured arm.
Follow-up appointments with an orthopedic surgeon are scheduled, typically within one to two weeks. Patients are often given initial home exercises or a prescription for physical therapy to begin soon after, and driving is strictly prohibited while taking narcotic pain medications.