A fracture is a break (full or partial) in one of the bones. Fractures are often caused by some kind of traumatic high-impact injury, or as the result of stress due to overusing the bone. Some medical conditions – such as cancer or osteoporosis – cause weakening of the bones which can result in pathological fractures.
In this article we will explore three common upper limb fractures that we treat in the clinic.
Proximal Humerus Fractures
A proximal humerus fracture is a fractured shoulder. This type of fracture occurs close to or within the ball part of the ball and socket joint.
Causes: Proximal humerus fractures are most commonly seen in older patients, particularly those with a condition like osteoporosis. They are normally the result of a fall onto an outstretched arm.
Who is most at risk: This type of injury is more common in older people, particularly women, however, it can also occur in younger people as the result of some kind of traumatic accident. People with osteoporosis, diabetes and epilepsy may be at increased risk.
Treatment: You will need to wear a sling to immobilise the shoulder joint. Most proximal humerus fractures do not require surgery, however, more complex cases may require surgical repair, including open reduction internal fixation (ORIF – most commonly with a plate and screws) or shoulder replacement if more severe.
Recovery: It can take up to 12 weeks for the bones to heal but physiotherapy is usually started after 3 weeks to prevent the joint from becoming excessively stiff. However, following a proximal humerus fracture it is not unusual to lose some motion in your shoulder.
Distal Humerus Fractures
A distal humerus fracture is a fracture to the elbow that occurs at the lower end of the humerus (upper arm bone). This is one of the three bones that come together to form the elbow joint. A fractured distal humerus is painful and makes moving the elbow impossible.
Causes: Distal humerus fractures are often the result of a traumatic injury or heavy blow to the elbow, for example during a vehicle collision. Older people may be at risk of this type of fracture caused by a fall.
Who is most at risk: This type of fracture is most common in older women and young men. Nearly a third (30%) of all elbow fractures involve the distal humerus. The patient may also sustain other associated injuries, such as a dislocated elbow or floating elbow.
Treatment: You will need to wear a sling to immobilise the elbow joint. In addition, distal humerus fractures often require surgical repair. Your surgeon may suggest open reduction and internal fixation (ORIF) or an elbow replacement.
Recovery: You will need to wear a splint and/or for up to two weeks after surgery and begin a programme of exercises thereafter post-surgery to strengthen the elbow joint and restore flexibility.
Humeral Shaft Fractures
A humerus shaft fracture is a painful fracture to the middle of the upper arm bone. This type of fracture can also cause damage to the radial nerve, which runs around the upper arm and down to the hand. An injured radial nerve can result in hand and wrist weakness and may mean you can’t pick things up or carry things effectively in the affected hand.
Causes: It is normally the result of a direct blow to the upper arm, which may be due to falling onto an outstretched arm or some kind of heavy impact such as that which occurs during a vehicle collision.
Who is most at risk: This type of fracture is associated with falls in older patients. In younger people it is most often the result of some kind of more significant traumatic injury.
Treatment: Humeral shaft fractures can often be treated without surgery using a brace to hold the bones in place for up to 12 weeks. While this is usually effective, some fractures may require surgical repair, most commonly open reduction and internal fixation (ORIF) or intramedullary nailing.
Recovery: In some cases, this type of fracture can lead to complications like radial nerve palsy. In most cases this improves naturally, but this can take up to 18 months and if this problem persists, you may require a nerve graft or tendon transfer.
Each of these types of fractures carries a risk of complications and long-term problems if not treated correctly.
It is important to get a prompt diagnosis if a fracture is suspected and to begin the right course of treatment as soon as possible.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
