Humerus Fractures

The humerus is the arm bone between the shoulder and the elbow. Humeral fractures are very painful. While some humeral fractures can be treated non-operatively, many humerus fractures require surgery in order for them to heal in an appropriate position with good function.

Fractures of the humerus that extend into the elbow are very serious injuries, as the joint surface is usually fragmented into multiple pieces. Humerus fractures that enter the elbow joint are technically difficult to treat and should only be fixed by an experienced elbow surgeon. The surgery is done on an outpatient basis. The ulnar nerve is moved to the front of the elbow to keep it away from the plates placed to fix the humerus, that could otherwise irritate it. The olecranon, the bone near the tip of the elbow, often needs to be cut through and repaired in order to expose the elbow joint for fixation. Therapy usually starts within the first week after surgery. A fair amount of therapy is usually needed to regain functional elbow motion.

Fractures of the humeral shaft (the long part of the bone that makes up most of the arm) are not quite as complicated. Humeral shaft fractures that are minimally-displaced (ie. it haven’t moved much) or are long fractures with a lot of surface area available for healing, can often be treated without surgery. However, displaced fractures or short fractures that don’t have a lot of area available for healing are usually best treated surgically, using plates and screws. I’m not a fan of rods for the humerus: the rate of fracture non-healing, as well as post-operative shoulder pain and stiffness, is too high for me. Following plate fixation of a humeral shaft fracture, therapy is started within the first post-operative week. The amount of therapy needed following these injuries is usually much less than that required for humeral fractures that enter the elbow joint.

In summary, humeral fractures are serious injuries that often require surgery for optimal treatment. The best treatment results may be obtained by seeking out an upper extremity sub-specialist.

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