The humerus is the single bone of your arm. Its upper plan ends in the humeral head and forms part of the shoulder. Its lower part is called the distal humerus and forms part of the elbow. A humeral shaft fracture is a break right in between, involving the middle part of the humerus. This is a common fracture, especially in the elderly.
A humeral shaft fracture is usually caused by a low-energy fall in older individuals, or by high-energy injuries, such as road traffic accidents, in the young. These fractures can also happen in contact sports.
Symptoms of a humeral shaft fracture include:
• Arm pain
• Swelling and bruising in the arm that can track down the rest of the upper limb
• Inability to lift the arm
• Radial nerve palsy – your nerve may fall asleep or get bruised, causing a numb patch in your wrist and hand, as well as inability to lift your wrist or straighten your fingers
The doctor will see you, take a detailed history and perform a physical exam focused on your neurovascular status, taking care not to cause any further pain and discomfort. An x-ray is usually sufficient to confirm the diagnosis. Your doctor may request further imaging to help with planning, typically a CT scan, especially if surgery is contemplated and your fracture extends towards the joints.
Most humeral shaft fractures are treated conservatively with great success. You will typically be fitted with an adjustable humeral brace (often called a Sarmiento brace). Fracture healing might take 8-12 weeks, but your doctor will encourage you to mobilize early to regain your range of motion. Some fractures may benefit from surgery. This is the case when broken pieces stick out of the skin (open fracture), your nerve has fallen asleep (controversial), the fracture lines extend towards the joint, you have multiple injuries, and you need to use crutches in order to get out of bed. In such cases, you may be a candidate for open reduction and internal fixation. Your surgeon will make an incision in the front or the back of your arm depending on the exact location of your fracture, put the broken pieces together and fix them with plates and screws. An alternative means of fixation more rarely used is a humeral nail. If your nerve has fallen asleep, your surgeon may opt to go from the back and explore it, to make sure it’s not entrapped in the fracture site or injured. After surgery, your surgeon and physiotherapist will create an individualized rehabilitation program for you. You don’t need any brace after surgery and early mobilization is advised. If you have a nerve palsy, this may take many weeks to recover.
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