This may be done with or without surgery. If surgery is needed, the surgeon may use devices such as pins, plates, or screws to hold the bone together. You will then wear a sling, splint, or cast to keep the bone in place and protect it from injury during healing. Other treatments may be also used to help reduce symptoms or regain function. These include:. Pain medicines. Taking prescription or over-the-counter pain medicines may help reduce pain and swelling.
Doing certain exercises at home or with a physical therapist can help improve strength, flexibility, and range of motion in the shoulder, arm, or elbow. Understanding a Humerus Fracture When you have a humerus fracture, it means that your upper arm bone is broken.
What causes a humerus fracture? Some surgeons fix the fracture because they believe that infection is less likely and less damaging if the fracture is held still. Other surgeons do the debridement surgery to clean up the wound but treat the patient in a cast after that, because they believe that minimal interference with the blood supply of an open fracture is better.
External fixation with a frame and pins may be used in some open fractures after the debridement surgery. Another strong indication for surgery is the presence of multiple injuries. If the patient has been in an accident with fractures to the legs or the other arm it may be better to fix the fractured humerus so that the arm can be moved as one.
It is very awkward to nurse a patient with a cast on the arm and a broken leg. Using crutches may be difficult until the fractured arm is strong enough. This stage is reached more quickly with surgical fixation. The third major reason of undertaking surgery to fix a fractured humerus is when the result from non-operative treatment would be un-acceptable in the judgment of the surgeon or after discussion with the patient.
Fracture patterns that result in unacceptable malunion or have a very high risk of nonunion would come into this category. The patient may prefer to have surgery in order to speed up recovery. Internal fixation with a plate and screws. The operation with plate and screws requires opening up the fracture, exposing the bone and putting the fragments together, then holding them in place with screws from a metal plate going into the bone.
This system affords rigid secure fixation and can also compress the bone fragments together. This aids healing. Exposure of the fracture site makes it possible to reduce the fragments exactly but it does disturb the blood supply of the fracture site. Bone graft can be placed in the fracture site to help healing if considered necessary. Removal of the implant plate and screws may be considered after the fracture has healed and consolidated especially if the site is tender or aching.
This operation requires a repeat of the exposure of the site but recovery is much quicker as the bone does not need major healing. Internal fixation with an intramedullary rod. With intramedullary fixation IM rod of the humerus the fracture is reduced indirectly by manipulation without opening it up. A small exposure is made at the shoulder and a metal rod is inserted into the bone at the shoulder, passed down inside the bone and across the fracture into the lower fragment.
This lines up the bone fragments correctly. The bone is held securely by screws passed through the bone and into the rod at both ends. The main advantage of this method of fixation is that the fracture site is not disturbed so the blood supply of the bone fragments may survive better. It is also very strong mechanically. Technically it is a difficult operation requiring special instruments and an X-ray system to view the fracture during the surgery.
The top end of the rod may be irritating and make shoulder movement painful. It is almost always necessary to remove the rod once the fracture has healed.
Removal of the rod is a relatively minor operation that does require an anesthetic but is usually done as a day surgery procedure. External fixation. With external fixation , strong metal pins are inserted into the bone fragments above and below the fracture. The pins are firmly attached to a frame that spans across the fracture. This holds the fragments immobile while the bone heals. The arm itself can move while in the frame so hand and elbow function does not deteriorate. Because the alignment of the fracture can be adjusted after the frame has been applied this technique is often used for the more complicated fractures and ones in which there is bone loss.
If this technique is used the pins and the frame are removed as soon as the bone has healed sufficiently. This procedure does not usually require a general anesthetic. The fracture may need to be protected in a brace for a period after removal of the frame. While you are in the cast simple finger movements, neck range of motion exercises as well as pendular exercises to assist with pain and maintain your shoulder range of motion will be your only exercises.
Surgical fixation aims to make the fracture site stable therefore in most cases gentle non-weight bearing exercises to maintain range of motion are safe to do early on and will often be recommended even immediately after surgery. In other cases, rehabilitation will not be recommended until after the bones have shown some evidence of healing on X-ray usually around six weeks.
Each surgeon will set his own specific restrictions based on the type of fracture, surgical procedure used, personal experience, and whether the fracture is healing as expected. If your humerus has been surgically repaired, maintaining general cardiovascular fitness can be done with lower extremity fitness activities such as walking or using a stationary bike or stepper machine. If your fracture has been casted, activities such as these may need to wait until the bone shows some healing on X-ray as the cast is used more for traction rather than total immobilization.
After surgical fixation, weights or weight machines for your lower extremity and opposite arm are also acceptable to use as long as the restrictions regarding your healing humerus are strictly abided by. Generally, lifting any weight with your injured limb will not be allowed and will be difficult as your humerus heals so you may require a friend to assist you with your workout setup if you are keen to continue while your bone heals.
When the initial cast is removed or immediately after surgery, you may experience some pain when you start to move your shoulder, wrist, elbow and forearm. If you were in a cast this pain is from not using the joints regularly.
If you have had surgery, the pain is likely from the surgical process itself. Your pain may also be from concurrent soft tissue injury that occurred when you fractured your humerus. Your Physical Therapist will focus initially on relieving your pain. We may use modalities such as heat, ice, ultrasound, or electrical current to assist with decreasing any pain or swelling you have around the fracture site or anywhere along the arm, into the shoulder or into the hand.
Due to some of the muscles of the neck and upper back connecting to the shoulder, you may also have some pain in these regions that we will treat in order to make movement of your entire upper body easier.
We may massage the neck, upper back, shoulder, elbow, forearm, or wrist to improve circulation and assist with the pain. The next part of our treatment will focus on regaining the range of motion, strength, and dexterity in your wrist, hand, elbow, and shoulder. If you have been casted, your arm will look and feel quite weak and atrophied after the cast is removed. Your Physical Therapist will prescribe a series of stretching and strengthening exercises that you will practice in the clinic and also learn to do as part of your home exercise program.
These exercises may include the use of rehabilitation equipment such as light weights or Theraband that provide added resistance for your upper limb. We may also use an upper body bike to encourage coordinated movement of the entire upper limb. If necessary, your Physical Therapist will mobilize your joints.
This hands-on technique encourages the stiff joints of your shoulder, elbow, and wrist to move gradually into their normal range of motion. Fortunately, gaining range of motion and strength after a humeral fracture occurs quickly. You will notice improvements in the functioning of your limb even after just a few treatments with your Physical Therapist. As your range of motion and strength improve, we will advance your exercises to ensure your rehabilitation is progressing as quickly as your healing fracture allows.
Graduated heavier exercises and endurance work will be added in concordance with the known healing time of bone in order to ensure the stresses can be withstood. As a result of any injury, the receptors in your joints and ligaments that assist with proprioception the ability to know where your body is without looking at it decline in function.
A period of immobility will add to this decline. Although your humerus is not traditionally thought of as weight-bearing bone, even an activity such as assisting yourself with your arms to get out of a chair or pulling a glass from a cupboard requires weight to be put through or lifted by your humerus and for your body to be proprioceptively aware of your limb.
If you are an athlete, then proprioception of your upper extremity is paramount in returning you to sport after a humerus fracture. Your Physical Therapist will liaise with your surgeon regarding the optimal time to start exercises that target proprioception by putting weight through the healing humerus bone via the hand.
These exercises might include activities such rolling a ball on a surface with your hand, holding a weight up overhead while moving your shoulder, or push- ups on an unstable surface.
Advanced exercises will include activities such as ball throwing or catching. For athletes we will encourage exercises that mimic the quick motions of the sports or activities that you enjoy participating in.
Over time, most patients are able to return to all activities they were doing before the injury. If, however, during rehabilitation your pain continues longer than it should or Physical Therapy is not progressing as your Physical Therapist would expect, we will ask you to follow-up with your surgeon to confirm that the fracture site is tolerating the rehabilitation well and ensure that there are no hardware issues that may be impeding your recovery.
Complications after any fracture can include fat embolism syndrome, deep venous thrombosis DVT , pulmonary embolism and compartment syndrome. Although all of these problems can occur with fractures of the humerus they are not especially common. Complications such as malunion, nonunion, infection, and nerve injury occur more frequently in a humeral fracture so will be discussed here. Unless a fracture has been operated on and fixed, it is rare for the alignment of the fracture to be exactly right.
Most often this is acceptable but the angulation or rotation at the fracture site can be great enough to cause problems. This would result in inability to lift the arm fully out to the side or fully forward. Because the arm can rotate a lot these restrictions of motion may not be apparent and so may not need to be corrected.
However, if they are significant the malunion can be corrected by surgery. This would normally involve an operation to cut the bone and fix it in the corrected position. This amounts to a new fracture with the same long period of healing so correcting a malunion is not undertaken lightly. If the malunion is treated by surgery one would expect healing and recovery of full range of motion and function. Delayed union is said to occur when the fracture has not formed a bridging callus by three months.
This is relatively common but there is still a good chance that the fracture will go on to heal. In rare cases, the bone completely fails to heal.
This is called nonunion. This complication occurs most often after cast treatment as the fracture is not immobilized, but it can also occur after surgery. The proximal humerus is one of the most commonly broken bones in older people.
It can occur after a normal fall or trip. Due to it being weaker in older people, the bone often breaks in multiple pieces. For children and younger adults, a higher energy injury like motor vehicle crashes, falls from height, and sports is needed to break the proximal humerus. Because of the many muscles that attach to this part of the humerus, it can break in many different ways, and you need to talk to your doctor about the specific type of fracture you have.
Proximal humerus fractures usually hurt a lot, especially when you try to move your arm. Simple breathing will cause pain. There may be a lot of swelling and bruising in your armpit, your chest, and down your arm. You may even have bruising in your hand or even fingers. When you first see a doctor, he or she will examine your shoulder and arm, and x-rays will be taken.
Unless you have other injuries, most of the time you will be able to go home and will not be admitted to the hospital. You will likely be given a sling to use.
Lying flat in a bed after a proximal humerus fracture can cause pain, so it may be more comfortable to sleep in a recliner chair. It is important to move your elbow, wrist, and hand to prevent stiffness. You should make an appointment with an orthopaedist or your primary care doctor for follow-up. Most proximal humerus fractures can be treated without surgery. The broken bone will take 3 to 4 months to heal. During this time, you will need to perform exercises to regain range of motion, strength, and return to normal activities.
Even if surgery is performed, recovery of full function often takes as long as 18 months.
0コメント