The humerus is the long bone of the upper arm, extending from the shoulder joint down to the elbow. A fracture of the humerus is a break in this bone, commonly resulting from a fall onto an outstretched hand or a direct blow. These injuries range from simple cracks to complex breaks involving multiple bone fragments. Treatment depends on the fracture’s location, the pattern of the break, and whether the bone fragments remain aligned.
Understanding Humerus Fracture Types
Treatment for a broken humerus is individualized because the bone can fracture in three distinct regions. A proximal humerus fracture occurs near the shoulder joint at the upper end of the bone. This type is common in older adults and often involves the ball-shaped head of the humerus.
A mid-shaft fracture, also known as a diaphyseal fracture, occurs in the central, long portion of the bone. This area requires substantial force to break. The radial nerve wraps closely around the bone here, making it susceptible to injury.
The third type is a distal humerus fracture, located near the elbow joint, which is often associated with more complex joint injuries. The degree of displacement strongly influences the prognosis and treatment choice. A non-displaced fracture means the bone pieces are still in acceptable alignment. Conversely, a displaced fracture means the bone fragments have shifted significantly out of position, often requiring intervention to restore the proper anatomy.
Non-Operative Management Strategies
Many humerus fractures, particularly those that are non-displaced or minimally displaced, can be managed without surgery. This non-operative approach focuses on immobilizing the arm to allow natural healing to bridge the gap between the bone fragments. The choice of immobilization device depends on the fracture location.
Mid-shaft fractures are frequently treated using a functional brace or a coaptation splint. These devices rely on ligamentotaxis, where the weight of the arm and gravity help maintain the bone fragments in an aligned position. Proximal fractures are typically immobilized in a simple sling or a shoulder immobilizer for two to three weeks to manage initial pain and swelling.
Initial healing for many non-operative fractures takes approximately six to eight weeks. Close clinical monitoring with repeat X-rays is essential during the early weeks to ensure the fracture fragments do not shift out of acceptable alignment as swelling decreases.
Surgical Repair Techniques
Surgery becomes necessary when a fracture is unstable, severely displaced, or involves the joint surface. Indications for operative treatment also include open fractures, where the bone breaks through the skin, or concurrent damage to nerves or blood vessels. The goal of surgical fixation is to achieve anatomical reduction and hold the bone fragments securely in place to facilitate healing.
The most common technique is Open Reduction Internal Fixation (ORIF). This involves making an incision to visualize the fracture site, realign the bone, and secure it with a metal plate and screws. Plating provides strong, stable fixation for complex fracture patterns and is often preferred for fractures near the joint surfaces. However, plating for mid-shaft fractures carries a risk of injury to the radial nerve during the procedure.
An alternative technique is Intramedullary Nailing (IMN), where a long metal rod is inserted down the central canal of the humerus. This rod stabilizes the bone from the inside, often requiring a smaller incision than ORIF. While both methods achieve comparable union rates, IMN is sometimes associated with a quicker time to union and a lower risk of infection for mid-shaft breaks.
Post-Treatment Recovery and Physical Therapy
Whether a fracture is treated with immobilization or surgery, recovery relies heavily on physical therapy (PT). The first stage focuses on protecting the healing bone while preventing stiffness in the shoulder and elbow joints. This often begins with gentle, passive range of motion exercises, such as pendulum swings, as early as two to three weeks post-injury or post-surgery, depending on fracture stability.
Once the initial healing period is complete and the bone shows radiographic evidence of consolidation, the program progresses to active-assisted and then active range of motion exercises. Strengthening exercises are introduced later, typically after six to twelve weeks, to rebuild the muscle mass and endurance lost during immobilization. These exercises are crucial for restoring the shoulder’s full function and stability.
While the bone may achieve initial stability in six to eight weeks, regaining full strength and pre-injury mobility is a much longer process. Patients should expect to participate in formal or home-based physical therapy for three to six months to achieve a near-full recovery. Monitoring for potential complications like joint stiffness (frozen shoulder) or persistent nerve irritation is an ongoing part of the rehabilitation process.