Fracture of the arm (humerus or humerus) is an injury to the bone that connects the shoulder to the elbow.
These fractures are relatively common in patients with osteoporosis.
Eighty percent of the fractures of the humerus in the proximal area (i.e. near the shoulder) are not or only slightly displaced and can therefore be treated without surgical intervention.
The fracture of the arm in the distal region (i.e. near the elbow) is associated with the fracture of the forearm in the proximal region.
Rarely, nerves and arteries are injured when the arm is broken. It is more likely that in addition to the fracture, there will also be a dislocation of the shoulder.
The attachments of the large pectoral muscle, deltoid muscle and rotator cuff muscles can cause displacement of the fragments of the humerus.
Stress fractures of the humerus occur due to repeated throws with the hand above the head and rarely due to violent muscle contractions.
These types of fractures occur almost exclusively in baseball pitchers.
As with other stress fractures, an increase in the activity or load on the bone is the most likely cause.
A greenwood fracture is a small and limited injury (similar to a tear) that occurs in children because their bones are more flexible and consist in part of growth plates.
Some fractures are more serious, for example: a fracture of the humeral neck is dangerous because it can cause a reduction in blood flow, resulting in bone necrosis.
The fracture of the diaphysis (shaft, central area of the bone) can lead to injury or strain of the radial nerve (spoke nerve).
Frequency
About 1.2% of all fractures are diaphyseal fractures of the humerus, while proximal fractures account for 5.7% of all bone fractures in the United States.
Age
Proximal humeral fractures are most common in older people with an average age of 64.5 years.
Proximal humeral fractures are the third most common after fractures of the hip and distal radius (wrist).
Humeral shaft fractures are more likely to occur in a slightly younger population with an average age of 54.8 years.
The fracture patterns are similar in all age groups, although older people are more prone to them due to osteoporosis.
Contents
Causes of arm fractures
Upper arm fractures are caused:
- by a direct blow (trauma) to the arm or shoulder;
- indirectly by a fall on the hand, with the blow transmitted via the elbow.
Distal humeral fractures can occur in different ways:
- A direct blow. This can happen in the event of a fall (direct landing on the elbow) or by hitting a hard object (baseball bat, dashboard or car door in a car accident).
- An indirect trauma. This can happen in a fall, when a person lands on the outstretched arm with an overstretched elbow. The ulna (one of the forearm bones) is pressed against the distal part of the humerus, provoking a fracture.
Symptoms of a broken arm
The pain is felt on palpation or movement of the shoulder or elbow.
Usually, bruising and severe swelling are observed.
A close medical examination must be carried out to determine whether arteries or veins have been injured.
In a humeral fracture, the radial nerve is injured relatively often.
In case of a proximal fracture of the humerus:
- Patients have shoulder pain and the ability to move is severely impaired.
- With an additional dislocation of the shoulder joint, the deformity is obvious; Swelling and bruising are consequences of this accident.
- Damage to the nervous system is rare in a proximal humeral fracture.
Bone shaft fracture
Patients have a deformed aching arm and may feel paralysis of the radial nerve. Normally, paralysis of the radial nerve is reversible.
- When moving, a crunch of the fracture site (so-called crepitation) can be felt.
- The shortening of the arm is caused by a displaced fracture.
- Patients who complain of pain when throwing, lifting or pushing the arm outwards could suffer from a stress fracture of the humerus.
- An examination may reveal numbness on the arm and an increase in pain during a resistance test.
Distal fractures
Distal humeral fractures can be very painful and make it impossible for the patient to move the elbow.
Other symptoms include:
- Swelling of the arm up to the hand
- Haematoma
- Touch pain
- Stiffness
- Feeling of instability
Examination of the radial nerve
The motor function of the radial nerve is to innervate the external muscles of the forearm. Motor tests should be:
- Stretching of the wrist and metacarpal base joints
- Spreading and stretching the thumb. Proximal injuries to the radial nerve cause sagging of the wrist (drop hand).
During the examination, the fingers are bent at the base joints of the metacarpal bones and the thumb is adduced.
Only rarely are the median nevus (median nerve) or the ulnar nerve (elbow nerve) affected.
For all humeral fractures, it must be checked whether the arterial pulse (heartbeat) is noticeable.
Differential diagnosis
The doctor must exclude:
- Shoulder dislocation
- Collarbone fracture
- Elbow fracture
- Shoulder blade fracture
- Bursitis of the shoulder joint
- Cervicobrachialgia due to nerve compression
- Bursitis of the elbow
Diagnosis
A thorough subjective and objective examination by the doctor is important to diagnose a humeral fracture. An X-ray examination is necessary to confirm the diagnosis and must always be performed if a fracture is suspected.
For distal and diaphyseal fractures of the humerus, anterior-posterior, lateral, thorax and shoulder armpit must be taken to get a detailed idea of a possible fracture.
A CT scan can be useful if the X-ray does not bring clarity.
How to sleep?
The best position is in the supine position (belly up) with a Desault bandage (which supports the forearm and is tied together behind the neck).
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