The medical term humeral shaft fracture refers to a bone fracture that occurs in the humeral shaft area. Due to the anatomy of the humerus and its proximity to the nerves (radial nerve) and blood vessels, different problems may very well occur – as part of the treatment of the injury. However, the prognosis is predominantly positive; complications – in the course of treatment – are rare to nonexistent.
What is a humeral shaft fracture?
Humeral shaft fracture (or also called humeral shaft fracture, humeral shaft fracture, or diaphyseal humerus fracture) describes the fracture of the humerus, or upper arm bone. In this case, the bone breaks in the shaft area (diaphysis). Treatment of the fracture, due to the surrounding blood vessels and nerves, is not uncomplicated, and concomitant injuries can sometimes occur, exacerbating the degree of injury.
Causes
Due to direct force (traffic accident, blow), a fracture of the humeral shaft may occur. However, indirect force effects (falls, twisting) are also possible causes of a humeral shaft fracture. It should be noted that the course of the accident certainly has an influence on the form of the fracture. While torsion or spiral fractures usually occur as a result of indirect force, lump and transverse fractures are possible as a result of direct force. In this case, the fracture zone also expands, so that direct force impacts sometimes cause greater damage than indirect force impacts. Very rarely, a humeral shaft fracture may also represent an open fracture; statistically, 6.3 percent of all humeral shaft fractures are so-called “open fractures.” The accident sequence also has an enormous impact on possible concomitant injuries. If there is direct trauma, the musculature and also the subcutaneous fatty tissue can be injured. Hemorrhages may be present or muscle cords may tear. Sometimes a compartment syndrome can also be triggered. For this reason, the physician must also be careful to consider any other injuries that may have occurred as part of the humeral shaft fracture as well.
Symptoms, complaints, and signs
The classic symptom is the formation of swelling. The swelling is also accompanied by bruising. The patient further complains of severe pain and a simultaneous restriction of movement. If there is an injury to the nerves (radial nerve), the so-called “drop hand” occurs. This means that the patient can no longer extend the hand. In about 20 percent of all cases, the radial nerve is also injured. If there is indirect trauma, it must be assumed that the nerve is torn. Only rarely is a tear of the nerve or several nerves diagnosed. Sometimes the nerves may also be “impaled” – due to the fractured end of the bone. During reduction (setting of the fracture), it is quite possible that injuries may occur due to the anatomical conditions. For this reason, reduction should be done extremely carefully.
Diagnosis and course of the disease
If a humeral shaft fracture is suspected, the physician makes a clinical diagnosis. The main focus is on the mobility or immobility of the shoulder and elbow joints, any pain in the fracture area, and also consideration of crepitations (grinding). Those clinical indications are clear information that a humeral shaft fracture is present. Nevertheless, the patient is x-rayed so that, on the one hand, the diagnosis can be confirmed and, on the other hand, the extent of the injury can be recognized. The course of the fracture is also decisive for further therapy, so that an X-ray must always be performed. Only in very few cases are further examinations – such as a computer tomography – prescribed so that any joint involvement can be excluded or diagnosed. As part of the clinical examination, the physician also pays attention to the nerve supply to the hand and forearm and also checks the blood circulation. In particular, the radial nerve is examined for any injury, due to the frequency of injury in humeral shaft fractures. Any damage to the radial nerve can be visualized by EMG. The course of the disease and the prognosis are positive.It does not matter whether the physician opts for a conservative or surgical method or whether there was an indirect or direct impact that caused a humeral shaft fracture. Depending on any concomitant injuries, healing processes may be delayed, so the first order of treatment is patience.
Complications
Due to the fracture, there is primarily relatively severe pain in the affected area and usually also swelling. The affected person suffers from movement restrictions, which can not infrequently lead to psychological discomfort. The patient’s everyday life is also made considerably more difficult by these restrictions and pain. Should rest pain occur, it can also lead to sleep problems. In general, the severe pain of humeral shaft fracture leads to irritability. In most cases, a quick diagnosis is possible, so that early treatment can also occur. There are no particular complications during treatment. A cast is placed around the affected area so that it cannot move, and the affected person must wait for the fracture to heal. Complications can occur if the humeral shaft fracture is not treated or the patient exposes himself to unnecessary stress during healing. In severe cases, surgical intervention is also necessary. Life expectancy is not altered by the humeral shaft fracture. Furthermore, the affected person can usually use the affected area after healing.
When should you see a doctor?
In any case of a humeral shaft fracture, a doctor must be consulted. If this fracture is not treated by a doctor, in the worst case scenario, the bone may grow together incorrectly, requiring surgery for treatment. The doctor should be consulted for the humeral shaft fracture if the affected person suffers from severe pain and swelling in the respective region. Therefore, especially after an accident or after a violent impact, an examination by a doctor should be performed. Furthermore, restrictions in movement indicate the humeral shaft fracture. The fracture can also damage the nerves, so that the affected person suffers from sensory disturbances in the hand. In many cases, the injury is clearly visible, so no additional examination is necessary for diagnosis. In an acute emergency, the humeral shaft fracture may require a visit to the hospital or the call of an emergency physician. However, the general practitioner can also diagnose this fracture and continue to treat it. There is usually a positive course of disease and no further complications.
Treatment and therapy
In almost all cases, the attending physician opts for conservative treatment. In this case, the physician applies a so-called Gilchrist bandage; sometimes an ordinary upper arm cast can also be missed. The bandage or cast is worn for about two weeks. The condition of the fracture is then checked and, if necessary, the bandage or cast is applied for a further week or two. However, if there is damage to the vessels, the physician prefers to use the surgical method. Especially if nerves or soft tissues have been injured or if there is an open fracture, conservative treatment is not promising. Surgery is also performed in the case of bilateral fractures or a so-called interposition of soft tissues found in the fracture gap. In the context of defect fractures, surgery is also performed. In case of osteosynthetic treatment, plate osteosynthesis or intramedullary nailing is performed. If there is an open fracture, which is treated surgically, physicians often opt for a fixator.
Outlook and prognosis
The prognosis of humeral shaft fracture is tied to the age of the patient and the severity of the fracture sustained. As the patient ages, the prospect of complete recovery steadily decreases. Bone strength decreases with age and damage to the skeletal system does not fully regenerate. If the bone is slightly fractured, the prognosis is favorable. The bones grow together with good medical care, resulting in freedom from symptoms. Normally, the healing process lasts several weeks or months until the body of the affected person is fully resilient again.If there is a complicated fracture with chipping, surgical intervention is necessary. Bones are replaced and auxiliary parts are installed, which are needed to strengthen the bones. If the operation proceeds without complications, the patient can move the arm sufficiently with an installed intramedullary nail or a fixation. Full functionality and resilience is not always achieved with the assistive devices, but there is a significant improvement in health. If medical treatment is not sought, lifelong impairments and discomfort may result. The bones either do not grow together at all or grow together crookedly. This is likely to result in a persistent restriction of the usual range of motion and low weight-bearing capacity.
Prevention
A humeral shaft fracture usually cannot be prevented. It is advisable to avoid any indirect or direct force; however, because this is not always possible, no actual preventive measures can be recommended that will ultimately prevent a humeral shaft fracture.
Follow-up
In the case of a humeral shaft fracture, there are usually very limited measures or options for aftercare available to the affected person. However, these are also not necessary, because in the case of a humeral shaft fracture, medical treatment by a physician must be carried out first and foremost in order to properly alleviate the symptoms. There are also no particular complications, so that there is usually also a positive course of the disease. As a rule, the life expectancy of the affected person is also not reduced by this disease. The treatment of this injury is usually carried out by means of a bandage or by plastering the affected area. The affected person should take care not to put unnecessary strain on the affected area and should not perform any physical or strenuous activities. Sporting activities should also be avoided. Furthermore, regular examinations and checks by a doctor are very important so that the humeral shaft fracture can heal properly. Early diagnosis is also of great importance in this regard. In some cases, patients are limited by this disease in their daily lives and therefore also need help and support from their own family or friends and acquaintances.
What you can do yourself
As a rule, humeral shaft fracture cannot be treated by means of self-help. In this case, the fracture is always treated by a doctor, and immobilization is the most important point of the treatment itself. In this case, there are no further complications and usually complete healing. The affected person should take care to wear the bandage or cast for several weeks according to the doctor’s instructions and not remove it himself. In some cases, surgical intervention may also be necessary if vessels have been damaged. Here, too, the affected person has no means of self-help. Avoiding the use of force can generally prevent the humeral shaft fracture. During the course of treatment, the affected region should not be subjected to unnecessary stress, as this slows healing. The affected person is severely restricted in his everyday life by the humeral shaft fracture and often needs the help of other people. In this case, the help of friends or the patient’s own family has a very positive effect on the course of the disease. In the case of psychological complaints, conversations with close friends are also very helpful. As a rule, a positive course of the disease occurs with the humeral shaft fracture.