ARM FRACTURE, HUMERUS
DEFINITION--A complete or incomplete break in the humerus, the large bone in the upper arm extending from the elbow to the shoulder. The most common fractures of the humerus occur in the tubercle (top part of the humerus that fits into the shoulder joint) or in the neck or shaft of the humerus.
BODY PARTS INVOLVED
Elbow and shoulder joints.
Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.
SIGNS & SYMPTOMS
Severe arm pain at the time of injury.
Swelling of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal arm contours.
Tenderness to the touch.
Numbness and coldness in the arm and hand if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the bone. Indirect stress may be caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports such as football or hockey.
History of bone or joint disease, especially osteoporosis.
Children under 12 or adults over 60.
If surgery or anesthesia is needed, surgical risk increases with smoking or use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
If you have had an arm injury, use padded arm splints when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Hospitalization (sometimes) for anesthesia and surgery to set the fracture.
Whirlpool, ultrasound, or massage to displace excess fluid from the injury area.
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of injured areas, including joints above and below the primary injury site.
AT THE TIME OF INJURY:
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over the fracture), or at the incision following surgery.
Shortening of the injured humerus.
Unstable or arthritic shoulder or elbow joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Proneness to repeated arm injury.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured arm to do so.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign the broken bones with surgery or, if possible, without. This manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
Immobilization will be necessary. It can take several forms, depending on the fracture:
(1) Placement of surgical nails or pins to hold bone fragments
together for fractures of tubercles. Usually only minimal external immobilization is necessary after surgery.
(2) Hanging cast for fractures of the neck of the humerus. A hanging cast is one placed on the lower arm to provide weight to overcome muscle spasms so the fractured bones will realign themselves.
(3) Shoulder-to-wrist rigid cast for uncomplicated shaft fractures.
If a cast is not necessary, continue R.I.C.E. instructions for 48 hours.
After 48 hours, apply heat. Localized heat promotes healing by increasing blood circulation in the injured area. If no cast is necessary, use hot baths, showers, compresses, heating ointments and liniments, or whirlpools. If a cast is necessary, use a heat lamp or heating pad so heat can penetrate the cast.
After the cast is removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
Narcotic or synthetic narcotic pain relievers for severe pain.
Acetaminophen for mild pain.
Stool softeners to prevent constipation due to inactivity.
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Begin reconditioning the arm after clearance from your doctor.
Resume your normal activities gradually after treatment. Don't drive until healing is complete.
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a fractured arm.
Any of the following occurs after surgery or other treatment:
Blue or gray skin color beyond the cast, particularly under the fingernails.
Loss of feeling below the fracture site.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Swelling above or below the cast.
Nausea or vomiting.