Mid Humeral Fracture
Introduction
The upper arm is made up of the humerus bone. The head of the humerus fits into a shallow socket in your scapula (shoulder blade) to form the shoulder joint. The humerus narrows down into a cylindrical shaft and joins at its base with the bones of the lower arm to form the elbow joint.
Fractures can occur at any site of the humeral bone. Mid humeral fractures are fractures that occur in between the shoulder joint and elbow. They are classified into Type A, B or C fractures. Type A fractures are simple fractures where the bone is not shattered. Type B fractures are fractures when the broken bone forms a wedge, and type C fractures are where the bone is shattered into many pieces.
Causes
Mid humeral fractures can be caused by:
- A direct blow or bending force applied to the middle of the humerus
- falling onto an outstretched arm
- violent muscle contraction in sports such as weight lifting
Signs and Symptoms
Patients usually present with considerable pain and swelling following a mid humeral fracture. Shortening of the arm is apparent with significant displacement of the bones.
Diagnosis
Mid humeral fractures can be diagnosed through X-ray imaging and ultrasound.
Treatment
Most mid humeral fractures can be successfully treated through conservative treatment without the need for surgery. Your doctor may place the limb in a hanging arm cast or a co-aptation splint for 1-3 weeks followed by a functional brace. Patients will be instructed on range of motion exercises of the fingers, wrist, elbow and shoulder as soon as can be tolerated.
Surgical treatment
Surgical treatment is recommended for
- Fractures that cannot be managed conservatively
- Segmental fractures
- Pathologic fractures (bone tumour)
- When blood vessels get injured
- Patients who need to have upper extremity weight-bearing capability
- Open fractures when the skin is opened up by the fractured bone
- Obese patients in whom alignment is difficult
Surgical treatment is called open reduction and internal fixation (ORIF). This procedure is usually performed under general anaesthesia. First your broken bones are put back into their normal anatomic position. Internal fixation devices such as plates, screws, or intramedullary (IM) implants are then used to hold your broken bones together. You will be placed in a dressing and/or cast following your procedure.
Risks and Complications
As with any surgery, complications can occur. Complications related to surgical repair of mid humeral fracture are rare but may include:
- Nerve injury
- Bleeding
- Infection
- Blood clots
- Recurrent instability
- Malunion or nonunion
- Hardware failure
Clavicle Fracture
Clavicle fracture, also called broken collarbone is a very common sports injury seen in people who are involved in contact sports such as football and martial arts as well as impact sports such as motor racing. A direct blow over the shoulder that may occur during a fall on an outstretched arm or a motor vehicle accident may cause the clavicle bone to break. Broken clavicle may cause difficulty in lifting your arm because of pain, swelling and bruising over the bone.
Broken clavicle bone, usually heals without surgery, but if the bone ends have shifted out of place (displaced) surgery will be recommended. Surgery is performed to align the bone ends and hold them stable during healing. This improves the shoulder strength. Surgery for the fixation of clavicle fractures may be considered in the following circumstances:
- Multiple fractures
- Compound (open) fractures
- Fracture associated with nerve or blood vessel damage and scapula fracture
- Overlapping of the broken ends of bone (shortened clavicle)
Plates and Screws fixation
During this surgical procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates to hold the bone fragments in place. These plates and screws are usually left in the bone. If they cause any irritation, they can be removed after fracture healing is complete.
Pins
Placement of pins may also be considered to hold the fracture in position and the incision required is also smaller. They often cause irritation in the skin at the site of insertion and must be removed once the fracture heals.
Complications
Patients with diabetes, the elderly individuals and people who make use of tobacco products are at a greater risk of developing complications both during and after the surgery. In addition to the risks that occur with any major surgery, certain specific risks of clavicle fracture surgery include difficulty in bone healing, lung injury and irritation caused by hardware.
Percutaneous elastic intramedullary nailing of the clavicle is a newer and less invasive procedure with lesser complications. It is considered as a safe method for fixation of displaced clavicle fractures in adolescents and athletes as it allows rapid healing and faster return to sports. The procedure is performed under fluoroscopic guidance. It involves a small 1 cm skin incision near the sternoclavicular joint, and then a hole is drilled in the anterior cortex after which an elastic nail is inserted into the medullary canal of the clavicle. Then the nail is passed on to reach the fracture site. A second operation to remove the nail will be performed after 2-3 months.
