Fractures of the humeral shaft are painful and can be debilitating injuries. Most, however, heal uneventfully without long term problems or limitations. The most common treatment of these injuries involves the use of cast braces and the majority of humeral shaft fractures do not require surgery. Surgical repair is limited to fractures which have a high propensity for late problems. This includes open fractures (fractures in which the bone punctures the skin), concomitant radial nerve injury, patients with multiple fractures (especially lower extremity fractures) and obesity. There is a large nerve called the radial nerve that runs along the back of the humerus and actually sits on bone for several inches throughout its course. Fractures in this area may injure the nerve. Patients with radial nerve injuries have a “wrist drop” which is an inability to extend the wrist or fingers in the involved hand.
If surgery is warranted, fixation options include nails and plates. There is very little difference in healing rates and the risk profiles are comparable in experienced hands. Implant choice is a matter of surgeon preference coupled with an informed decision by the patient. The relatively open approach used for the placement of the plate results in larger incisions than those when placing a nail while inserting a nail usually requires a small incision (that is later repaired) through the rotator cuff tendon.
Complication rates with humeral plating are fairly low, but the incisions required to repair these fractures are long and not particularly cosmetic. In cases where the bone is lined up well, the long term functional outcome is the same with or without surgery. So if a cast or brace can maintain the position of the bones, this is the preferred treatment. With non-operative treatment, the first few weeks after sustaining a humerus fracture are very difficult for most patients as its hard to find a comfortable position. Most patients report “feeling” a clicking sensation at the fracture site. This subsides after a few weeks and most patients are relatively comfortable after about 2-3 weeks. After about 3-4 weeks, patients transition to a fracture brace and are encouraged to begin moving their elbow. This muscle function helps to keep the bone lined up and stimulates healing of the fracture. The brace is used for about 8 weeks and full contact is permitted no earlier than 6 months after the injury. We use two orthotics manufacturers close to the downtown area. They are responsive and do really nice work in helping to customize fracture braces. You can click on either link below to view their website and find the nearest location to you.
This website allows you to purchase the fracture brace directly from the manufacturer. Although this may save you some money, if there is a problem with the fit of the brace, you are on your own.
If the fracture is not amenable to non-operative management surgical repair is recommended. After fixation, recovery is surprisingly quick and most patients have return of function of their arm within 4-6 weeks. Therapy to regain range of motion in the shoulder and elbow are critical to obtain a good outcome. The implants placed during surgery are usually permanent and rarely require removal at a later date.
Click here to see a post-operative arm fracture instruction sheet.