humerus fracture
The humerus bone is in the upper arm and extends from the shoulder to the elbow joint. Breaks of the humerus bone can be due to falls, motor vehicle accidents, tumors, or direct trauma to the arm. Many humerus fractures will heal without surgery. The optimal treatment depends on the location and orientation of the break, and the alignment of the broken pieces. Regardless of treatment type, complications such as shoulder or elbow stiffness or weakness, non-union (failure to heal), or nerve injury (particularly the radial nerve) may occur.
Non-surgical treatment
Many humerus fractures can be successfully treated non-surgically. Breaks near the top of the humerus near the shoulder (proximal humerus fractures) may be treated in a sling.
Breaks in the middle of the humerus bone (humerus shaft fractures) are oftentimes treated in a “Sarmiento brace”, which is sometimes referred to as “functional bracing”. This is a removable plastic brace/splint which wraps around the arm and has velcro straps that can be tightened to squeeze the fracture fragments together.
Breaks near the elbow (distal humerus fractures) can sometimes be treated in a removable plastic splint along the backside of the arm/elbow that holds the fracture aligned.
Non-surgical treatment with a brace. Many humerus fractures can be treated without surgery. The humerus shaft fracture above was successfully treated in a “Sarmiento brace”, which wraps around the upper arm and holds the bone aligned while it heals.
Surgical treatment
Some humerus fractures are treated surgically. Surgery may be indicated in fractures that enter into the elbow or shoulder joint, fractures that are not well aligned, or in patients that find bracing unacceptable. The optimal surgery technique depends on the location of the break, but typically involves either a metal plate and screws or a metal nail that goes down the inside of the humerus bone.
Humeral nail. Fractures in the middle of the humerus bone can oftentimes be treated with a metal nail that enters the inside of the humerus bone from the top, near the shoulder, and spans across the fracture. Several screws are placed through the nail to prevent rotation or shifting. This is a less invasive technique, that allows for patients to return to using the arm within the first week or two.
Humerus ORIF (open reduction internal fixation). A “distal” humerus fracture is a break at the end of the humerus bone that oftentimes will extend into the elbow joint. These fractures are oftentimes treated with a metal plate and screws to hold the pieces together. Aligning the joint surface is important for restoring motion and function.
Humerus non-union. A “non-union” is a fracture that does not heal on its own. This humerus fracture did not heal despite ~8 months in a brace, and despite the use of a bone stimulator (image on left). For humerus non-unions that do not heal in a brace, surgery with bone graft, a metal plate, and screws can be successful (as shown in the image on the right).
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.