Humerus fracture

About Humerus Fracture

The humerus is the long bone of the upper arm that extends from the shoulder to the elbow.

Humerus fractures refer to any break in this bone and are generally divided into three types according to the part of the bone which is injured.

• Proximal humerus fracture, is an injury in the top of the arm bone, near the shoulder.
• Distal humerus fracture is an injury in the bottom of the bone near the elbow.
• Any fracture in between is called mid-shaft of the humerus.

Distal humerus fractures are much more common in children and often require surgical treatment.

What causes humerus fracture

The most common cause for humerus fractures are falls.

Car accidents and sports injuries, such as ski or football, may also cause a humerus fracture and sometimes it can occur when the bone is weakened by other pathologic conditions such as tumour or infection.

What are the symptoms of a humerus fracture?

Symptoms vary depending on the type of fracture but may include:

• Pain
• Swelling
• Inability to move the shoulder
• Deformity
• Loss of normal use of the arm
• Instability in the elbow joint (in case of distal humerus fracture)
• Bleeding and bone sticking out of the skin (in case of open fracture)

Humerus fracture diagnosis

The orthopedic surgeon may ask you to do some movements with your arm, to determine what kind of fracture you have and examine the anatomical segment.
An X-ray of the arm is fundamental to determine the site and type of the fracture and the best treatment including always both shoulder and elbow joint.

What is the treatment for a humerus fracture?

Most humerus fractures heal without surgery if the bone fragments are not displaced (shifted out of position).

The majority of patients can be treated with a non surgical approach using sling, brace or shoulder immobilizer. While casting is not possible with most types of humerus fractures.

Surgery is usually required when the bone fragments are far out of position (displaced).

Fractures close to the shoulder and elbow joints, such as Distal Humerus Fractures, are more likely to require surgery.

Open reduction and internal fixation are the most often used procedure to treat humerus fractures.

During this procedure, the bone fragments are first reduced (repositioned) into their normal alignment and then held in place with plates and screws attached to the outside of the bone.

There are two main approaches:

• Pins, screws and plates. In case of an open fracture, when a piece of bone sticks through the skin, surgery usually involves internal fixation of the fragments using pins, screws and plates
• Bone grafting. The orthopedic surgeon may take a piece of bone from another part of the body or use an artificial material and add it to the humerus. This happens when some of the bone has been lost or severely smashed.

External fixation
In case of severe open fracture, the orthopedic surgeon may perform an external fixation.
The external fixator helps hold the elbow in a good position until a until a second surgery can take place.

Physical therapy is always recommended whether or not surgery is needed. This will help strengthen the arm muscles and regain the full range of motion.

The patient’s cooperation is essential to the rehabilitation process.

Prof. Nicola Portinaro’s experience

Prof. Portinaro is has been treating humerus fractures for more than 30 years.

He has personally performed more than 300 surgeries both in adults and child  with good results