A humerus bone fracture, also known as an upper arm fracture, is often the result of a fall or trauma. While it particularly affects older people due to osteoporosis, sports injuries or accidents can also lead to an upper arm fracture. This type of fracture can affect the humerus head, the shaft or the area near the elbow and is treated either conservatively or surgically, depending on its severity.

Schulter und Arm

Overview

Fractures of the humerus bone are often caused by severe force following a fall on the upper arm. In older people with bone loss (osteoporosis), a slight fall with support on their arm is sometimes all it takes.

Uncomplicated fractures can be treated conservatively without surgical intervention. This is particularly the case if no soft tissue is affected or no bone fragments are displaced or splintered. Complicated fractures such as open fractures, those near the joint or humerus head fractures very close to the shoulder joint (shoulder fractures) generally require surgical intervention.

Types of humeral fractures

There are three main types of humerus bone fracture: the proximal humerus fracture, which affects the upper region of the humerus near the shoulder – this includes humerus head fractures and subcapital humerus fractures; the humerus shaft fracture, which affects the middle region of the bone, and the distal humerus fracture, which occurs at the lower end of the bone near the elbow.

Treatment goal

The main goal of surgery for a humerus bone fracture is to restore the natural bone structure. Care must be taken in the process to ensure that the bone fragments are aligned correctly in order to avoid later mobility restrictions. If the fracture is stabilised using screws, plates or other fixation methods, patients can regain extensively normal function of the arm once it has healed.

Surgical procedure

Treatment of an upper arm fracture usually takes place on an outpatient basis and is performed under regional anaesthesia, usually in the form of an interscalene block. Patients are often given an additional sedative. On frequent occasions, a shoulder arthroscopy is performed at the start of the intervention if the fracture is located near the shoulder joint or in the joint itself. Depending on the nature and location of the upper arm fracture, different osteosynthesis procedures are used. These involve the use of screws, intramedullary rods, plates and, in severe cases, prostheses to restore the stability of the bone.

Percutaneous screw fixation

With percutaneous screw fixation, the bone fragments are fixed in place using screws as part of a minimally invasive procedure. Following small incisions, the fracture is first precisely aligned under fluorescent monitoring. A guide wire (Kirschner wire) is then drilled through the fracture and into the desired position. In the next step, a bone screw is screwed in via this wire to fix the fracture securely in place. The wire is removed at the end of the procedure. In most cases, two to three screws are required to ensure stable fixation of the fracture.

Intramedullary rods

Intramedullary rods are mainly used to treat fractures below the shoulder joint. During this procedure, a special nail is inserted into the bone marrow cavity to stabilise the fracture from the inside.  The intramedullary rod connects the bone across the fracture line and is fixed in place using cross bolts to prevent it from moving.

Plate fixation (plate osteosynthesis)

Fixation using metal plates is particularly useful when it comes to treating complex fractures of the humerus bone. First, the bone fragments are precisely aligned using wires. A customised titanium plate is then placed on the humerus bone and screwed to both the stable bone segments and the fragments. Once the plate has been securely anchored, the wires can be removed again. In order to prevent fluid from accumulating, a surgical drain is usually inserted before closing the surgical wound.

Shoulder prosthesis

roentgen-schulterprothese-mit-ohne-schaft
Radiographie d'une prothèse d'épaule

Sometimes, complex fractures consisting of several fragments require the insertion of a shoulder prosthesis. This procedure is discussed in the chapter “Shoulder prosthesis”.

Preparation and precautions

The exact situation of the humerus fracture is usually revealed by an X-ray examination. In more complex cases or if the findings are unclear, an MRI examination can also be performed. All of the standard preliminary examinations such as blood tests, blood pressure measurements and an electrocardiogram, are also carried out before surgical treatment.

If patients are taking blood-thinning medications, these must be discontinued in good time in consultation with a doctor. In addition, it is important to fast before the operation, meaning that patients must refrain from eating for at least 6 hours before the surgery and from drinking any fluids for 2 hours before the operation.

Aftercare and recovery

The first mobility exercises are performed as early as during the hospital stay, which usually lasts about five days. It usually takes a week before simple activities such as eating, washing or writing are possible again. A shoulder sling takes weight off the arm for a few weeks to aid in the healing process. In most cases, the fracture has healed completely after 6 to 12 weeks. It is very important to perform physiotherapy exercises regularly to prevent the shoulder joint from becoming stiff and to restore full mobility.

After percutaneous screw fixation, the metal needs to be removed after 3 to 4 months. Titanium plates can be left in the body as long as they do not cause any discomfort.

Potential complications

The surgical treatment of upper arm fractures usually progresses without any major complications. As with all surgical interventions, infections, nerve injuries, bleeding or blood clots may occasionally occur. In rare cases, parts of the bone (humerus head necrosis) may die off. If this occurs, an artificial shoulder joint needs to be inserted afterwards.

Centres 10