After a fall on the arm or shoulder, a fracture of the humerus should be considered if there is an additional restriction of movement in addition to severe pain. Older people in particular are in the risk group for this fracture.
What is a fracture of the humerus?
A fracture just below the head of the humerus is called a subcapital humerus fracture. Usually, this type of humeral fracture involves the head of the humerus as well. These fractures occur relatively frequently after accidents or falls. In these cases, patients fall on their shoulder or on their outstretched arm. The humerus is narrow at this point and also less hard than at other points and can therefore break more easily. If osteoporosis is present in addition to the accident, there is an increasing risk of this fracture. If a fracture of the humerus occurs without external impact, a metastasis or tumor may be causative for the injury.
Causes
The cause of a humeral fracture (subcapital humerus fracture) is the application of force to the shoulder or outstretched arm during an accident or fall. Athletes injure themselves while riding bicycles or motorcycles but a fall while horseback riding or skiing can also result in this fracture. Elderly people are also often affected by a fracture of the upper arm due to their increasing unsteadiness when walking and the resulting falls and a possibly additionally present osteoporosis. Specifically, the group of 60 to 80-year-old women suffer this fracture twice as often as men of the same age.
Symptoms, complaints, and signs
A fracture of the upper arm is associated with clear and typical symptoms, so self-diagnosis is often very easy. In most cases, there is severe swelling associated with a fracture of the humerus, which is clearly visible. Of course, this is also associated with considerable pain, so that the entire range of motion is very severely restricted. Under certain circumstances, there may even be an open fracture. In such a case, the fracture of the bone can be detected with the naked eye. Of course, an open fracture should be treated medically and with medication. In some cases, surgery is even necessary to straighten the bones and allow a smooth healing process. However, one also speaks of an upper arm fracture when a small hairline fracture is present. A hairline fracture is a very small crack in the bone, but it causes much less pain than a fracture. Nevertheless, such a small crack in the humerus also causes pain that can last for a very long time. Affected individuals often simply suspect a strain or muscle strain. In many cases, a hairline fracture in the upper arm grows back together very quickly, so that no medical treatment is necessary. However, if typical symptoms occur, such as swelling and bruising, then a doctor should be consulted as soon as possible.
Diagnosis and course
A fracture of the humerus is usually noticeable by a restriction of movement in the shoulder or arm and severe pain. The injured tissue swells noticeably and the arm is held against the body in a protective position. D
he fall may also result in the development of a large bruise on the shoulder and/or in the armpit, as well as on the side of the patient’s chest. It may appear after a few hours or not until the next day. These complaints alone will cause an affected patient to see the doctor. After a detailed anamnesis discussion, the doctor can make a definite diagnosis by taking several X-rays. If it is suspected that the cause of the fracture is a tumor, an MRI (magnetic resonance imaging) examination is also performed. Depending on the accident, it may be necessary to rule out the possibility that ligaments have been affected or that there is even a dislocation of the shoulder in addition to the humeral fracture. Computerized tomography (CT) is used for this purpose.
Complications
Complications due to a humeral fracture are rare. Thus, the chances of recovery are considered good with both conservative and surgical therapy. Major movement restrictions also usually occur only in isolated cases. One of the immediate sequelae of a humerus fracture is hypovolemic shock. This is when the circulating blood rapidly decreases.This in turn threatens fainting of the injured person. Another conceivable complication is the formation of thrombophlebitis. In this case, blood clots form and block the arteries. The thrombi also carry the risk of pulmonary embolism. If parts of the thrombus detach, there is a risk that they will enter the circulation and block arteries there. The risk of sequelae is highest if the fracture of the upper arm occurs in the area of the scapula and clavicle. If, on the other hand, the fracture occurs in the elbow region, the risk of complications is lower. Injury can also affect arteries, muscles and nerves. A late consequence of the humeral fracture is pseudarthrosis. In this process, the bone does not consolidate properly. Furthermore, a fibrous callus may form. If surgical treatment of the humeral fracture takes place, there are also risks. These include blood clots, bruising, infection and secondary bleeding. If nerves are injured, this can sometimes result in sensory disturbances or paralysis. Furthermore, allergies to implants can occur.
When should you go to the doctor?
If the affected person suffers from pain of the arm or severe restrictions of movement after a fall or accident, a doctor is needed. The individual should refrain from taking a pain medication on his or her own until a medical professional has been consulted. If the shoulders or arm can no longer be moved as usual, medical care is needed. Swelling of the arm, discoloration of the skin, and sensitivity problems need to be examined and treated. Bruising, tension or deformation of the skeletal system are signs of an irregularity that must be discussed with a physician. If the physical load capacity decreases, the gripping function of the fingers can no longer be performed or abnormalities of the heart rhythm appear, a visit to the doctor is advisable. If the patient is no longer able to perform everyday tasks or sports activities, action is required. Pressure sensitivity of the arm and shoulder, numbness or hypersensitivity to perceived stimuli are further signs of a health impairment. A visit to the doctor is necessary, as medical help should be initiated as soon as possible for an optimal healing process in the case of an upper arm fracture. Behavioral changes, a whiny demeanor in children, and withdrawal may be further indications of an irregularity. If pain continues to spread or the body’s ability to bear weight continues to decrease, the affected person needs a comprehensive medical examination.
Treatment and therapy
In about 80 percent of patients, a humeral fracture can be treated without surgery. For this purpose, the arm is fitted with a special bandage, known as a Gilchrist or Desault bandage, or a splint, which immobilizes it for about two weeks. It is important to restore mobility at an early stage with physiotherapeutic applications. However, if the bone is broken into several pieces, surgical treatment must be performed. The same applies if blood vessels or nerves have been damaged or if damage is imminent as a consequence. At the beginning of the operation, the fracture is first straightened under X-ray control. At this point, the patient is already under anesthesia. The bone is then stabilized with screws, wires or plates. The surgical method used depends on the severity of the fracture. Once healing has progressed and the pain has subsided, mobility must be restored through physiotherapy. The materials inserted during the operation must be removed again after some time. This is now often possible through tiny incisions or endoscopically.
Outlook and prognosis
It is difficult to make a general statement about the prognosis of humeral fractures, and it is highly dependent on the type and location of the fracture, the treatment method and initiation, and the patient’s age and any preexisting conditions. Simply stated, simple fractures have a good chance of uncomplicated healing with complete or near-complete recovery of function of the affected arm if treated correctly and in a timely manner.In the case of a successful surgical treatment, foreign material (plates, screws) can often remain in the body for the rest of the patient’s life without any problems, so that follow-up operations and metal removal can often be avoided. However, if a complicated fracture shape, individual pre-existing conditions (e.g. osteoporosis, circulatory disorders, nicotine consumption, etc.) or incorrect post-treatment (e.g. too early or incorrect load build-up) complicate the healing process, permanent consequential damage such as pain, restricted mobility and/or malpositioning may be quite possible. A longer treatment period and possibly further surgical measures may then become necessary. In these cases, however, complete freedom from symptoms cannot always be achieved even after conservative and surgical options have been exhausted. Early and professional treatment as well as adequate physiotherapeutic care are in any case decisive prerequisites for a course that is as free of complications as possible.
Prevention
A humeral fracture can hardly be prevented by active measures, since the risk generally increases with age. However, it is important to counteract the early onset of osteoporosis, as this condition further promotes such fractures. This includes sufficient exercise as well as a calcium-rich diet. It has also been proven that maintaining general mobility, especially in old age, significantly reduces the risk of falls and thus the likelihood of suffering a fracture of the humerus.
Aftercare
Follow-up care requires that symptoms actually need to be relieved. This is familiar from cancer, for example. Medical professionals research neutumors with the help of imaging techniques. A fracture of the humerus, on the other hand, does not entail the need for such follow-up care. As a rule, there are no functional limitations for the upper arm after therapy. Due to the absence of symptoms, there is no justification for regular X-rays. If, on the other hand, there is a complicated fracture and other accompanying circumstances such as old age or a weakened immune system, the healing period is prolonged. This makes follow-up care over a period of months necessary. The doctor and patient agree on regular check-ups. Imaging procedures such as X-rays or ultrasound examinations provide clarity about the healing progress. If necessary, a physiotherapist is consulted. Follow-up care also aims to prevent the recurrence of symptoms. For the humerus fracture, this means not allowing a corresponding fracture to occur. However, this cannot be the responsibility of a physician, because the violence occurs in the context of unpredictable accidents. A physician therefore advises an ill person to avoid certain risk activities. However, this is the sole responsibility of the patient.
Here’s what you can do yourself
In the case of an upper arm fracture, the affected person should take sufficient care of himself. Carrying heavy objects, performing sports activities or exerting force should be refrained from. Movements should be performed slowly and calmly, especially at the beginning of the healing process, to avoid complications. In the case of a fracture of the humerus, the arm is often immobilized and immobilized. Therefore, a restructuring of everyday life is necessary. Daily tasks and procedures are to be performed with the healthy arm or should be performed by people in the close environment. In special cases, the patient can hire a nursing service to get sufficient support. Stress and hectic should be refrained from when performing everyday tasks. In addition, the patient helps himself by not allowing mental stress to arise or by reducing it through the use of mental relaxation techniques. To prevent tension, light balancing movements should be performed several times a day. In addition, the organism should be provided with sufficient heat so that possible muscle stiffness can be reduced. During the healing process, the body needs sufficient vitamins, minerals and trace elements. By eating a healthy and balanced diet, the patient can strengthen his immune system and thus promote recovery. Towards the end of the treatment, muscle building and an increase in the range of motion can be started, given the patient’s physical capabilities.
