Humeral shaft fracture

Definition

Humeral fractures account for about 7% of the total number of fractures. Depending on the localization, shoulder fractures are divided into fractures of the upper humerus, diaphyseal fractures of the shoulder (fractures of the middle part of the shoulder), and fractures of the lower humerus. Shoulder fractures are accompanied by pain and swelling, deformation and crepitation in the fracture area, and limitation of arm movement. In intra-articular fractures of the shoulder, hemarthrosis is possible. The main method of diagnosing a humerus fracture is radiography; ultrasound, CT, or MRI of the joint, and diagnostic puncture may be performed. Treatment includes repositioning of the fragments, their retention with the help of spokes, plates, or screws, application of a plaster cast, and rehabilitation of the arm after removal of the cast (massage, therapeutic exercises, physiotherapy).

Anatomy

The upper end of the humerus is hemispherical and joins the articular surface of the scapula to form the shoulder joint. The part of the humerus immediately below the head is called the anatomical neck of the humerus. Just below it are the muscle attachment points – the small and large tuberosities. The shoulder joint capsule covers the shoulder’s anatomical neck and ends above the tuberosities. Below the tuberosities, the bone narrows slightly to form the surgical neck of the shoulder. The lower part of the humerus ends with the rounded head of the condyle articulating with the radius and the humerus block articulating with the ulna.

Classification

Depending on the localization, traumatologists categorize shoulder fractures into:

• upper humerus fractures;
• diaphyseal fractures of the shoulder (fractures of the middle part of the shoulder);
• lower humerus fractures.

fractures of the shoulder in its upper regions can be intra-articular and extra-articular.

Proximal fractures

Fracture of the head, tear of the small or large tuberosity, and fracture of the anatomical and surgical neck of the shoulder are possible. Fractures of the surgical neck are the most common, with the vast majority of victims being elderly. The fracture is usually caused by a fall on the elbow, shoulder, or outstretched arm.

Symptoms

The patient complains of pain in the area of the shoulder joint. Puncture fractures are accompanied by indistinct swelling and pain when attempting active movements. Passive movements are insignificantly limited. With a displaced fracture, the clinical picture is more vivid. The victim is bothered by pronounced pain. Moderate swelling, deformation of the joint area, and shortening of the limb are detected. Crepitation (crunching of bone fragments) is determined. The diagnosis is clarified by the results of radiography. In case of intra-articular fracture, an ultrasound of the shoulder joint may be performed.

Treatment

In case of embedded fractures, the arm is fixed with a special bandage. In surgical neck fractures with displacement, repositioning is performed in the Department of Traumatology under local anesthesia. Subsequently, fixation with a Turner dressing or on a diverting splint, leucoplast, or skeletal traction is possible. Physical therapy is prescribed starting from 7-10 treatments. The period of immobilization is six weeks. Surgery is indicated for unstable and splinter fractures. Contraindications to surgery are old age and severe chronic diseases.

Diaphyseal fractures

Fractures of the shoulder in the middle section (diaphyseal fractures of the shoulder) occur due to a fall on the arm or a blow to the shoulder and can be oblique, transverse, screw-shaped, or splinter fractures. Diaphyseal fractures of the shoulder are often combined with damage to the radial nerve. The brachial arteries and veins may be injured.

Symptoms

Clinical signs of shoulder fracture include pain, swelling, deformity, bone fragment crepitation, and abnormal mobility of the humerus. In shoulder fractures with radial nerve damage, the patient cannot independently straighten the fingers and hand. A radiographic examination is performed to clarify the diagnosis and choose the treatment tactics.

Treatment

Fractures of the shoulder without displacement are anesthetized and fixed with a plaster splint. In displaced shoulder fractures, skeletal or leukoplasty traction is applied, replaced with a plaster cast after radiologic signs of bone callus appear. The total period of immobilization in diaphyseal fractures of the shoulder is 3-3.5 months.

In well-aligned shoulder fractures combined with radial nerve injury, conservative therapy is performed (adequate immobilization of the shoulder fracture, drug stimulation of nerve regeneration, physical therapy, and physical therapy). If there are no signs of nerve regeneration within 2-3 months, surgery is performed. Surgical treatment is indicated for multifocal fractures of the shoulder, the impossibility of closed repositioning, the interposition of soft tissues, and vascular damage. Fixation of the fragments is performed using plates, metal pins, or Ilizarov apparatus.

Distal fractures

Intra-articular and intra-articular fractures of the lower shoulder are possible. Extra-articular fractures of the lower shoulder include supramuscular fractures, while intra-articular fractures include block fractures, humeral head fractures, and intermuscular fractures.

Epicondylar fractures

Based on the mechanism of injury, suprascapular fractures of the shoulder are subdivided into extensor and flexor fractures. Flexion suprascapular fractures are more common and occur when falling on a flexed arm. An extensor fracture is caused by a fall on an overextended arm.

Symptoms

The area of the shoulder above the elbow joint is swollen and sharply painful. Flexion fractures are accompanied by visual elongation of the forearm; in extensor fractures, the forearm looks shortened. Suprascapular shoulder fractures may be combined with dislocation of the forearm bones. The diagnosis is made after radiography.

Treatment

In uncomplicated fractures, the area of injury is fixed with a plaster cast for 3-4 weeks. In case of large displacement of the fragments and impossibility of repositioning, surgery is performed.

Fractures of the condyles

A fracture of the external condyle is caused by a fall with support on the extended arm; a fracture of the internal condyle is caused by a fall on the elbow. Direct trauma (a blow to the condyle area) is possible. The elbow joint is swollen and sharply painful. As a rule, condyle fractures are accompanied by the development of hemarthrosis (accumulation of blood in the elbow joint), in which pain and swelling become more pronounced. The diagnosis is established after radiography.

Treatment

In non-displaced fractures, immobilization with a plaster cast is performed. In displaced fractures, repositioning is performed under local anesthesia. If the fragments cannot be matched, surgical treatment is performed (fixation of the fragments with spokes, plates, or screws). Physiotherapeutic procedures for this type of shoulder fracture are contraindicated. Patients are prescribed physical therapy and mechanotherapy.

Transcondylar fractures

Common in children. They occur when you fall on your elbow. They are accompanied by pain, swelling, and joint movement limitation. Treatment is the same as for condyle fractures.

All these treatment options are available in more than 830 hospitals worldwide (https://doctor.global/results/diseases/humeral-shaft-fracture). For example, Intramedullary nailing can be done in these countries for following approximate prices:

Turkey $2.8 K in 29 clinics

China $10.5 K  in 8 clinics

Germany $10.7 K in 43 clinics

Israel $13.4 K 14 clinics

United States $15.9 K in 15 clinics.