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 tumor)
- 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 anesthesia. 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
Conclusion
Mid humeral fractures can be managed effectively both through conservative and surgical methods depending on the type of fracture. The treatment of mid humeral fractures is associated with a union rate of 90%.