Humerus fracture fixation
The treatments that are most well-suited for a distal humerus fracture depend on a number of factors including age, current health, the severity of the fracture and history of various medications and treatments. Humerus fracture, which is a complete or partial breakage of the upper arm bone, is most commonly caused by trauma, particularly a fall, and accounts for three percent of all fractures.
A humerus fracture can reduce your ability to perform daily tasks easily. If you have any reason to think that you may have a fracture in your humerus, it is important to seek medical attention. To best diagnose your injury, your doctor will ask a series of questions about your health history and how the injury occurred. If the specific location of the breakage is not known, one or more of these tests will help locate its exact spot:
- X-ray (radiograph) – This is the first test done to determine the location of the fracture and the extent of the injury. It is done using electromagnetic radiation that is sent through the shoulder and upper arm area. Bone absorbs the radiation, making it appear on the transposed image. This test is usually sufficient to see the location and severity of the fracture.
- Computed tomography scan (CT or CAT scan) – A CAT scan is a combination of X-ray and computer technologies and may be used if the radiograph is not clear.
- Magnetic resonance imaging (MRI) – If further imaging is needed, or the patient cannot be exposed to more radiation, an MRI will be done. This uses magnetic fields that generate vibrations through radio waves aimed at the shoulder and upper arm area. These vibrations are then transposed onto a high-definition computer image.
If the humerus fracture is stable or not displaced, a splint may be used to immobilize it while it heals. This type of nonsurgical approach will be monitored throughout the healing process to ensure that there are no complications and that the bone is healing as it should. Once the doctor is certain that there are no bone fragments or anything out of place, the patient may be able to start moving the arm after a few weeks. This will help speed the recovery time. The patient still will be advised to avoid lifting anything heavy until the fracture has healed completely.
In cases where a humerus fracture has been displaced or the bone has lacerated the skin, surgery will be required. The aim of most humerus fracture surgeries is to realign the bones and guide them as they heal. The vast majority of humerus fractures are treated using one of the following techniques:
- Internal fixation – Pins, metal plates and/or screws will be affixed to the bone to help reconnect the broken pieces and stabilize them for healing. The incision typically is made behind the elbow. Because of this, after surgery the patient will likely have to remain in a splint to reduce any strain on the incision.
- Elbow replacement – This is highly unusual, but when the lower part of the humerus has been damaged, the elbow may have received equal force from the impact and may need to be replaced. This surgery is done most commonly on elderly patients. A metal or plastic implant will be used to replace the elbow. The procedure is similar to that of a hip or knee replacement.
Much of the research surrounding humerus fractures has to do with those that occur in the elderly. Because the elderly are more inclined to have reduced bone density, they are at a significantly higher risk of breaking bones. The humerus is at particular risk because it is often broken when a person tries to brace a fall or falls on his or her side. More specifically, proximal humerus fractures account for 10 percent of all fractures in people over the age of 65.In the elderly, one of the main concerns is the length of time it takes for the humerus to heal. During this time, you are limited in the number of activities you can perform.
A study by the Mayo Clinic Department of Orthopedic Surgery took a look at one of the more controversial treatment methods for proximal surgeries in the humerus. It has long been controversial because it is believed to limit the ability of the elderly to move and therefore can lead to other health concerns such as blood clots or even death.
In the study, a hybrid approach of an implant combined with internal fixation led to fewer complications and better mobility following the surgery. A similar study was conducted by Brunner, and similar results were found. Additionally, it was determined that the length and number of screws used to position the bone were significant for the overall outcome of a patient’s health. It was not determined that the elderly were affected by the longer recovery time or limited mobility during that time.
As research on surgery to repair proximal humerus fractures is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs humerus fracture surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.