Compound Humerus Fracture: Symptoms, Causes, Treatment

Humerus is the bone of the upper arm that connects the shoulder to the elbow.¹ Bone fracture is a medical term used to define a break in the continuity of bone. There are 2 types of fracture – simple fracture and compound fracture. Simple fracture or closed fracture is a condition where there is a break in the bone, but the skin remains intact. In a compound fracture or open fracture, there is a break in the skin and the broken bone sticks out of the skin.

Compound humerus fracture or compound fracture of the humerus bone of the upper arm is comparatively uncommon. They are usually seen in cases of multiple injuries or direct trauma. There is higher risk of radial nerve palsy. Low grade compound fracture can be managed non-operatively after irrigation and debridement. In high grade compound fracture associated with soft tissue injury, surgical intervention is required.

Compound fracture of humerus is characterized by the following symptoms:

• Pain and tenderness over the site of fracture.
• Deformed appearance of the upper arm.
• Protrusion of bone through the skin is common sign of compound humerus fracture.
• Swelling, bruising and bleeding.
• Impaired or limited arm movement is also a symptom of compound humerus fracture.

In extreme cases, besides the above, the following warning signs have to be closely monitored to avoid complications:

• Stretch Pain: It is caused due to muscle trauma in the affected area. It is characterized by contraction and tenderness of the muscles around the humerus. If left untreated it can cause fibrosis of the muscle with lifelong deformities.
• Pale, Pulseless Extremity: This denotes injury to blood vessels and requires immediate attention.
• Foul Odour: Offensive odour from the wound is a sign of gas gangrene or necrosis.

The most common causes of compound humerus fracture include:

• Motor vehicle accidents are commonly known to cause compound humerus fracture
• Sports injuries can also cause compound humerus fracture
• Physical activities and hobbies such as dancing
• Falls
• Physical fights or assault including penetrative injuries by bullet, knifes etc
• Workplace injuries.

If compound fracture is left untreated, the following complications may occur:

• Chronic Osteomyelitis as a Complication of Compound Humerus Fracture: It is an infection of the bone that invades and damages the surrounding bone.
• Non-healing Fracture post Compound Humerus Fracture: Repeated trauma over the site of injury during the healing phase can cause non healing fracture or malunion of the bone.
• Delayed Wound Healing as a Complication of Compound Humerus Fracture: The site of wound may take prolonged periods of time to heal, which in turn will delay the fixation of the broken bone.

Primary diagnosis of compound humerus fracture includes physical examination followed by simple x-ray of the arm to determine the extent of the fracture. Larger wound may require further tests to determine the underlying infection, assess blood loss, bone loss, risk of contamination, circulatory shock etc.

Compound humerus fracture is usually accompanied by injury to other parts of the body. Thus, the first step would be stabilization of the general condition of the patient. The next step includes debridement and irrigation of the wound. This is done by removal of dead tissues and foreign bodies from the site of injury followed by cleansing the wound with saline water. Surgical intervention is required for fixation of the broken humerus bone. This is done using plates and screws internally and externally. The arm is then immobilized using a sling, to promote healing. In large wounds, grafting may be required.

Anti-inflammatories are prescribed for reducing pain associated with compound humerus fracture whereas antibiotics are prescribed for controlling infection. A tetanus shot is advised to prevent complications in view of direct exposure to external environment.

It is advised to wear appropriate clothing and gears with adequate protection and good footwear to reduce the risks of falls and impact of trauma while indulging in extreme physical activities and action sports. Calcium rich diet helps in strengthening bone thus reducing the risk of fracture.

Compound humerus fractures are a complex type of fractures that needs special attention. It is usually caused after a blow or trauma over the bone and it is characterized by exposure of the bone through the overlying structures. They are prone to infection and other complications. Compound humerus fractures need immediate care and usually treated by an orthopaedist or an orthopaedic surgeon. The treatment plan is decided based on the extent of the fracture and condition of the patient. The condition is managed by administration of the appropriate antibiotics, debridement and irrigation, and surgical fixations.

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