In most cases, episodes of humerus fractures are the consequence of physical trauma, accidental falls, excessive stress on the arm or particular health conditions (eg osteoporosis, bone tumors, etc.).
There are three main types of humerus fractures: proximal extremity fractures, body fractures, and distal extremity fractures.
Typical symptoms consist of: pain, bruising, swelling and difficulty in moving the arm.
For a correct diagnosis, physical examination, medical history and X-rays are almost always sufficient.
Treatment depends on the location and severity of the fracture.
Anatomy of the Humerus: a brief review
In the "human being, the humerus is the even bone that makes up the skeleton of the arm; the arm is the anatomical portion of the upper limb, which runs from the shoulder to the elbow."
The humerus belongs to the category of long bones and takes part in the formation of two important joints: the glenohumeral joint of the shoulder and the elbow joint.
Like all long bones, the humerus can be divided into three main portions: the so-called proximal end (or proximal epiphysis), the so-called body (or diaphysis) and the so-called distal end (or distal epiphysis).
- The proximal end of the humerus is the portion which forms part of the glenohumeral joint and which follows the shoulder;
- The body is the central portion of the humerus, between the proximal end and the distal end;
- The distal end of the humerus is the bony portion that forms part of the elbow joint and precedes the forearm.
From a functional point of view, the humerus is important because:
- It takes part in fundamental joints for the movements of the entire upper limb, arm in particular;
- It accommodates the muscles that support the movements of the aforementioned joints;
- In young children, it represents a support for four-legged locomotion.
The most typical classification of "humerus" fractures distinguishes the latter on the basis of the location of the break point and recognizes three major categories of injury: fractures of the proximal extremity of the humerus (or fracture of the proximal humerus) fractures of the body humerus and distal humerus fractures (or distal humerus fractures).
Anatomical significance of Proximal and Distal
In anatomy, proximal and distal are two terms with opposite meanings.
Proximal means "closer to the center of the body" or "closer to the point of" origin. Referring to the femur, for example, it indicates the portion of this bone closest to the trunk.
Distal, on the other hand, means "farther from the center of the body" or "farther from the point of" origin ". Referred (always to the femur), for example, indicates the portion of this bone farthest from the trunk (and closest to the "knee joint).
Fracture of the Proximal Humerus
In the "proximal end of the humerus", there are at least 6 regions of some anatomical importance: the head, the anatomical neck, the major tubercle, the minor tubercle, the intertubercular sulcus and the surgical neck.
Typically, proximal humerus fractures involve one of: the major tubercle, the minor tubercle, the surgical neck, and the anatomical neck.
As far as their epidemiology is concerned, fractures of the proximal extremity of the humerus represent, in the general adult population, 5.7% of all cases of bone fracture.
Fracture of the body of the humerus
Fractures of the body of the humerus involve the central part of the bone, between the proximal end and the distal end.
Regarding their epidemiology, fractures of the body of the humerus represent 1-3% of all cases of bone fracture in the general adult population.
Fracture of the Distal Humerus
Proceeding from top to bottom, the anatomically relevant regions of the distal end of the humerus are: the medial supracondylar crest, the lateral supracondylar crest, the medial epicondyle, the lateral epicondyle, the coronoid fossa, the radial fossa, the olecranon fossa, the trochlea and the capitulum.
In most cases, fractures of the distal humerus are located at the level of the supracondylar ridges.
As regards their epidemiology, they represent 2% of all cases of bone fracture in the general adult population.
etc;Fracture of the Proximal Humerus: the Causes
In most cases, fractures of the proximal end of the humerus result from accidental falls, in which the victim had his arm fully extended forward; more rarely, they are the result of sports injuries or traffic accidents.
The main risk factors for fractures of the proximal extremity of the humerus include: old age, the presence of osteoporosis or osteopenia and cigarette smoking.
Fracture of the body of the humerus causes
Among the most common causes of fracture of the body of the humerus, there are accidental falls - just like fractures of the proximal extremity - and physical trauma.
Among the less common causes, the metastases that originate from breast cancer and the assiduous repetition of the characteristic throwing gesture usually performed by baseball players deserve a mention.
Fracture of the Distal Humerus: the Causes
Generally, fractures of the distal end of the humerus are the result of severe physical trauma to the elbow. In such circumstances, the "olecranon of the" ulna "slides" violently upwards, right against the distal epiphysis of the humerus.
Types of Humerus Fracture
Depending on the characteristics of the so-called fracture gap, the humerus fracture can be:
- Transverse. The peculiarity of this injury is that the fracture gap is arranged at right angles to the "longitudinal axis of the" bone ("horizontal" fracture).
- Spiroid. The peculiarity of this injury is that the fracture gap follows a spiral course along the fractured bone.
- Butterfly. It is a middle ground between transverse fractures and spiroid fractures.
Fracture of the Humerus and Age: Who is Most at Risk?
People of any age can suffer a fracture of the humerus; however, in general, the most affected subjects are those who are approaching seniority: most patients, in fact, are over 55-60 years old.
Remaining on the subject, it is interesting to note that:
- The fracture of the proximal humerus has a particular incidence in the population over the age of 64, being among other things the third most common type of fracture after that of the hip and the distal portion of the radius;
- The fracture of the body of the humerus mainly affects a slightly younger segment of the population, between the ages of 54 and 55 on average.
- Arm pain
- Difficulty moving the arm
- Swelling in the arm
- Hematoma on the arm of varying size;
- Presence of abnormal sounds, similar to crackles, during movements of the affected arm.
If the cause of the fracture has also affected the good health of the nerves passing through the arm (eg: radial nerve, axillary nerve, etc.), there is a loss of skin sensitivity and / or muscle control in a part of the limb. superior.
If the factor causing the fracture has also caused an injury to the blood vessels of the arm (eg brachial artery), the patient is the victim of a reduced blood supply to the forearm and especially to the wrist.
Finally, if the fracture is displaced, the arm presents a more or less pronounced deformity and the individual victim of the injury has serious difficulties in bending the elbow.
Fracture of the Humerus: Pain and Hematoma
The pain resulting from a humerus fracture is immediate, in the sense that it appears immediately after the injury.
The painful sensation is so intense that the injured person struggles to make even the slightest movement with the affected arm.
As regards the hematoma, however, this characteristic sign is observable only after 24-48 hours from the injury. The size of a hematoma resulting from a humerus fracture varies in relation to the severity of the injury.
Fracture of the Humerus: Degree of Severity
A bone fracture can be compound or displaced, stable or unstable, simple or multi-fragmentary, closed or open, etc.
Generally, the least severe humerus fractures are compound, stable, simple and closed fractures, while the most severe humerus fractures are displaced, unstable, multi-fragmentary and open ones.
For further information: Types of Bone FractureFracture of the Humerus: Complications
The factor that causes a humerus fracture can also involve:
- Avascular necrosis (or osteonecrosis) of the head of the humerus;
- The injury of the axillary nerve;
- Dislocation of the glenohumeral joint;
- An injury to the rotator cuff.
For example, unlike X-rays, a CT scan can detect any involvement of the nerves in the arm or blood vessels.
Doctors use CT scans only if strictly necessary, since the examination in question, although totally painless, involves exposing the patient to a non-negligible dose of ionizing radiation that is harmful to humans.
Generally, in these circumstances, the cast involves the arm-shoulder complex (so that it is impossible to move the upper limb) and lasts about 6 weeks (minimum time necessary for the reunification of the bone fragments).
A severe fracture of the proximal extremity, on the other hand, requires the intervention of the surgeon, who must first reposition the bone fragments in their correct anatomical position, and then weld them together using screws, pins, etc.
At the end of the surgery, rest, immobilization of the arm-shoulder complex and the administration of painkillers against pain are mandatory.
Usually, rest and immobilization should last between 6 and 8 weeks.
Fracture of the Humerus Body: Therapy and Recovery Times
Most humeral body fractures are such that conservative treatment is sufficient.
As in the previous case, conservative treatment is based on: rest, immobilization of the arm-shoulder complex and administration of painkillers.
Surgery is rare and is usually expected when the fracture is associated with damage to the blood vessels or nerves in the arm.
Generally, rest and immobilization - whether treatment was conservative or surgical - should last between 6 and 8 weeks.
Distal Humerus Fracture: Therapy and Recovery Times
In general, the treatment of fractures of the distal end of the humerus is conservative and consists of: rest, immobilization of the arm-elbow complex and administration of painkillers.
The intervention of the surgeon is foreseen only in the presence of damage to the nervous and / or vascular structures, or in the presence of displaced, unstable, open fractures, etc.
Rest and immobilization must last until the bone fragments are reunited, which generally takes between 6 and 8 weeks.
Fracture of the Humerus: How to Know When You Are Healed?
Both in the presence of severe fractures and in the presence of minor fractures, the only way to ascertain the seal of the humerus is to observe its state of health, by means of an X-ray examination.
If, on the basis of the X-ray examination, any bone lesion persists, the treating physician is forced to re-immobilize the arm-shoulder or arm-elbow complex and recommend more rest.
Fracture of the Humerus and Rehabilitation: Physiotherapy
Any fracture of the humerus requires, after the period of rest and immobilization of the upper limb, a cycle of rehabilitative physiotherapy sessions (physiotherapy rehabilitation).
In such circumstances, physiotherapy serves to restore joint mobility of the shoulder and elbow, to strengthen the muscles of the upper limb immobilized for a long time, etc.
The ultimate goal of physiotherapy is to restore the normal function of the entire upper limb, which has suffered the fracture of the humerus.
Physiotherapeutic rehabilitation is important not only when the humerus fracture required surgical treatment, but also when it required only conservative therapy.
Humerus Fracture Surgery: what does it consist of?
Generally, surgery for a humerus fracture involves welding the bone fragments using pins, screws and plates, while waiting for the so-called callus to form (once this has formed, a second surgery will be needed for the removal of the various elements used for welding).
More rarely, surgery for humerus fractures involves an autologous bone graft; in practical terms, this means that the surgeon takes a fragment of bone from "another area of the body and places it where the fracture exists", to favor the welding of the fragments.
The use of this surgical technique usually occurs when the injury has involved the complete fragmentation of a part of the humerus.
Fracture of the Humerus: How to Sleep?
In the presence of a humerus fracture, doctors recommend sleeping with the torso erect and the injured arm dangling.
To implement the aforementioned precautions when sleeping, it may be useful to sit on an armchair or on a bed with some pillows behind it.
When sleeping, it is very important to avoid putting pillows under the injured arm: the latter, in fact, could push the shoulder upwards and compromise the healing process.
