Humeral fractures occur when the humerus or the bone of the upper arm gets injured or broken. The humeral fractures can occur on the shoulder, elbow or the middle portion of the upper arm. In case of closed humeral fracture, the humerus may get cracked or might get broken but is not exposed. The closed humeral fracture usually account for about four percent of arm fractures, which prevails in the elderly age group.
What is Closed Humeral Fracture?
Humerus is the long bone of the upper arm. Its head forms the ball and socket joint at the shoulder while the lower end forms the hinge joint at the elbow. The middle portion is called the shaft. When a heavy stress directly impacts the humerus, it may break and such a condition is known as humeral fracture. The fracture can be of different types ranging from minor hairline fracture to a fragmented one. In case of closed humeral fracture, the humerus may get cracked or might get broken but is not exposed. Humerus fractures are broadly categorized into three types, based on the site of injury. They are:
- Proximal Humeral Fracture: These fractures occur at the shoulder joint of the arm. The humerus forms the ball and socket joint. When this ball gets fractured the shoulder motion is severely hampered; however, it may or may not require surgery for treatment.
- Closed Distal Humeral Fracture: These fractures occur rarely and affect the elbow joint of the arm. The elbow joint protrudes from the lower end of the humerus in articulation with radius and ulna of the fore arm. When distal end of the humerus gets fractured then the movement of elbow is severely affected. For these fractures surgical treatment is a must.
- Closed Mid-shaft Humeral Fracture: The site of injury lies in between the shoulder and elbow. The fracture usually heals by itself. The injury commonly affects the radial nerve which in turn affects the wrist movement.
Symptoms of Closed Humeral Fracture
The common symptoms that come up as a consequence of closed humeral fractures are:
- Traumatic Pain in the arm is a symptom of closed humeral fracture
- Bruising and tenderness at the site of injury
- Swelling and inflammation at the site of injury
- Severe pain during movement
- Difficulty or inability in the movement of arm
- Tingling and numb sensation in the arm
- Stiffness in the joint
- Sensation of instability within the arm can be a symptom of closed humeral fracture.
Prognosis & Recovery Period of Closed Humeral Fracture
The prognosis and outlook for closed humeral fractures is mostly good with most cases healing without complications. The recovery period for most of the closed humeral fractures is usually between six to eight weeks. Most of the cases do not require surgery and heal gradually, but may result in stiffness and decrease in the range of motion. However, these after effects gradually subside with therapy, relaxation and exercising.
Causes of Closed Humeral Fracture
The prime underlying causes behind humeral fractures are:
- Road or automobile accidents can cause closed humeral fracture
- Heavy impact fall on the arm
- Sports injury
- Gun shots.
Risk Factors of Closed Humeral Fracture
The common threats or risk factors for closed humeral fractures are:
- Frequently falling on the same side of the arm
- Osteoporosis is one of the risk factors of closed humeral fracture
- Presence of vitamin B deficiency
- Involvement in sports like baseball which requires excessive amount of throwing.
Complications in Closed Humeral Fracture
There are several complications that can arise when closed humeral fractures are not taken care of appropriately or the damage caused by the fracture is severe. These are:
- Non-union of bones due to improper treatment and healing can be one of the complications of closed humeral fracture.
- Improper alignment of the broken bones resulting in poor positioning of the bone and deformity with adverse effects to the motility of the arm.
- Impaired sensation in arm due to nerve injury resulting in Reflex sympathetic dystrophy.
- Stiffness and weakness with loss of normal range of motion.
- Development of compartment syndrome due to increased pressure in the arm.
- Frozen shoulder.
Diagnosis of Closed Humeral Fracture
The diagnosis for humeral fractures involves below tests and examinations:
- Physical Examination for Closed Humeral Fracture: The physical examination involves analysis of the symptoms like bruising, swelling, pain, numbness and inability in movement of arm.
- Imaging Examination to Diagnose Closed Humeral Fracture: Apart from the physical examination, imaging tests are conducted for detailed analysis of the fracture. There are different diagnostic procedures depending on the site of injury in the humerus. These are:
- X-Ray Scan: It is conducted to obtain the anterior-posterior view, trans-scapular view and axillary views of the proximal humeral fractures.
- MRI: This is done in case of mid-shaft fractures in humerus to obtain anterior-posterior as well as lateral views of the fracture.
- CT scan: The CT scan checks for the distal humerus fractures which are not directly visible through above two procedures.
Treatment of Closed Humeral Fracture
The treatment of closed humeral fractures can be both surgical as well as non-surgical. These procedures are:
- Non-Surgical Treatment for Closed Humeral Fracture: These measures include:
- Pain Medication: The pain medication can be narcotic like acetaminophen, codeine and morphine or NSAIDs like ibuprofen, and naproxen. These medications are administered when the patient suffers from severe pain associated with closed humeral fracture but these are only for short term usage.
- R.I.C.E Therapy: R.I.C.E stands for rest, ice, compression and elevation. These measures should be followed for accelerated recovery and improved range of motion following closed humeral fracture. Along with this, usage of arm slings, cast and splint is also required.
- Physiotherapy: Recovery from fracture usually leaves behind stiffness, which can be successfully treated through chiropractic or physiotherapy sessions.
- Surgical Treatment to Treat Closed Humeral Fracture: Surgical treatments for closed humeral fracture are opted in severe cases when realignment of separated parts is required. Internal fixation is done to support the bone at the site of injury.
Prevention of Closed Humeral Fracture
The preventive measures that need to be followed to avert the chances of humeral fractures are:
- Taking of calcium and vitamin D supplements to prevent bone loss due to osteoporosis.
- Wearing proper safety gear when playing sports that have a probability of arm fractures.
- Maintaining proper balance especially at older age
- To minimize the risk of falling, safety measures like anti-skid mats, non-slip shoes, handrails, etc should be used.
Closed humeral fractures are a common injury of arm which usually results from heavy impact falling and direct trauma incidences. Amongst the proximal, distal and shaft fractures of humerus, the shaft fractures are quite common. Generally, the shaft and proximal fractures do not require surgical treatments and heal on their own but the distal fractures are the most severe cases which require surgical intervention. Closed humeral fracture usually heals in four months when proper care and precautions are followed.
- OrthoInfo – AAOS. (2021). Distal Humerus Fractures of the Elbow https://orthoinfo.aaos.org/en/diseases–conditions/distal-humerus-fractures-of-the-elbow/
- MedlinePlus. (2021). Humerus Fracture Repair https://medlineplus.gov/ency/article/002970.htm
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