Humeral fracture

A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding there elbow. Complications may include injury to an artery or nerve, and compartment syndrome. A fracture of the greater tuberosity as seen on AP X rayA fracture of the greater tuberosity of the humerusFracture of the greater tuberosity of the humerusMulti-fragmented, or comminuted fracture of the proximal humerus with involvement of the greater tuberosityProximal humerus fractureA transverse fracture of the humerus shaftA spiral fracture of the distal one-third of the humerus shaftA displaced supracondylar fracture in a child A humerus fracture is a break of the humerus bone in the upper arm. Symptoms may include pain, swelling, and bruising. There may be a decreased ability to move the arm and the person may present holding there elbow. Complications may include injury to an artery or nerve, and compartment syndrome. The cause of a humerus fracture is usually physical trauma such as a fall. Other causes include conditions such as cancer in the bone. Types include proximal humeral fractures, humeral shaft fractures, and distal humeral fractures. Diagnosis is generally confirmed by X-rays. A CT scan may be done in proximal fractures to gather further details. Treatment options may include a sling, splint, brace, or surgery. In proximal fractures that remain well aligned, a sling is often sufficient. Many humerus shaft fractures may be treated with a brace rather than surgery. Surgical options may include open reduction and internal fixation, closed reduction and percutaneous pinning, and intramedullary nailing. Joint replacement may be another option. Proximal and shaft fractures generally have a good outcome while outcomes with distal fractures can be less good. They represent about 4% of fractures. After a humerus fracture, pain is immediate, enduring, and exacerbated with the slightest movements. The affected region swells, with bruising appearing a day or two after the fracture. The fracture is typically accompanied by a discoloration of the skin at the site of the fracture. A crackling or rattling sound may also be present, caused by the fractured humerus pressing against itself. In cases in which the nerves are affected, then there will be a loss of control or sensation in the arm below the fracture. If the fracture affects the blood supply, then the patient will have a diminished pulse at the wrist. Displaced fractures of the humerus shaft will often cause deformity and a shortening of the length of the upper arm. Distal fractures may also cause deformity, and they typically limit the ability to flex the elbow. Humerus fractures usually occur after physical trauma, falls, excess physical stress, or pathological conditions. Falls that produce humerus fractures among the elderly are usually accompanied by a preexisting risk factor for bone fracture, such as osteoporosis, a low bone density, or vitamin B deficiency. Proximal humerus fractures most often occur among elderly people with osteoporosis who fall on an outstretched arm. Less frequently, proximal fractures occur from motor vehicle accidents, gunshots, and violent muscle contractions from an electric shock or seizure. Other risk factors for proximal fractures include having a low bone mineral density, having impaired vision and balance, and tobacco smoking. A stress fracture of the proximal and shaft regions can occur after an excessive amount of throwing, such as pitching in baseball. Middle fractures are usually caused by either physical trauma or falls. Physical trauma to the humerus shaft tends to produce transverse fractures whereas falls tend to produce spiral fractures. Metastatic breast cancer may also cause fractures in the humerus shaft. Long spiral fractures of the shaft that are present in children may indicate physical abuse. Distal humerus fractures usually occur as a result of physical trauma to the elbow region. If the elbow is bent during the trauma, then the olecranon is driven upward, producing a T- or Y-shaped fracture or displacing one of the condyles. Definitive diagnosis of humerus fractures is typically made through radiographic imaging. For proximal fractures, X-rays can be taken from a scapular anteroposterior (AP) view, which takes an image of the front of the shoulder region from an angle, a scapular Y view, which takes an image of the back of the shoulder region from an angle, and an axillar lateral view, which has the patient lie on his or her back, lift the bottom half of the arm up to the side, and have an image taken of the axilla region underneath the shoulder. Fractures of the humerus shaft are usually correctly identified with radiographic images taken from the AP and lateral viewpoints. Damage to the radial nerve from a shaft fracture can be identified by an inability to bend the hand backwards or by decreased sensation in the back of the hand. Images of the distal region are often of poor quality due to the patient being unable to extend the elbow because of pain. If a severe distal fracture is suspected, then a computed tomography (CT) scan can provide greater detail of the fracture. Nondisplaced distal fractures may not be directly visible; they may only be visible due to fat being displaced because of internal bleeding in the elbow.