Disease Description (Causes and Symptoms)
- Definition summary: A humeral (upper-arm) fracture refers to a condition in which external force causes the bone to break in the humeral region between the elbow and shoulder.
- Causes: Falls (falling from a height), traffic accidents, direct trauma (such as assault), and sports injuries. Pathological fractures caused by osteoporosis, bone tumors, metabolic bone diseases, and other conditions are also possible causes.
- Pathophysiology: When external force destroys the cortical bone and causes bone fragments to shift, the surrounding soft tissue, blood vessels, and nerves (especially the radial nerve) may be injured. Gaps or rotational deformity between bone fragments increase the risk of impaired blood supply and nonunion.
- Main symptoms: Localized pain and tenderness, swelling, muscle stiffness, deformity (protrusion of bone fragments or an abnormal axis), pinpoint bleeding of the skin (traumatic), sensory abnormalities or a tingling sensation (when nerves are injured), and bleeding or traumatic shock (in severe cases).
Treatment Methods (Standard Treatment, Medications, Procedures, Lifestyle Management, and Precautions)
- First aid
- Immobilization with a splint to prevent additional injury and bleeding and to relieve pain.
- Pain control (analgesics), treatment of bleeding and shock, and, in the case of an open fracture, consideration of decontamination, antibiotics, and tetanus vaccination.
- Record and repeatedly monitor the neurovascular status (palpation and checking sensation and movement).
- Imaging and evaluation
- Basic: X-ray (from multiple angles). If necessary, CT (especially for joint surfaces and complex fractures), MRI (for soft-tissue injuries), and bone scanning (when a pathological fracture is suspected).
- Nonsurgical treatment
- Treatment with a cast or functional brace after reduction (a functional brace is used for midshaft humeral fractures). This is indicated for stable, well-aligned fractures.
- Periodic radiographic follow-up to confirm alignment and union.
- Surgical treatment
- Indications: Significant displacement or inability to achieve union, open fracture, joint involvement, persistent nerve or vascular compression or injury, and patients with multiple injuries.
- Methods: Open reduction and internal fixation (ORIF) with plates and screws, intramedullary nailing, and external fixation devices.
- Infection prevention, thrombosis and hemostasis management, and nerve-function monitoring are necessary after surgery.
- Medications/supportive treatment
- Analgesics (nonsteroidal anti-inflammatory drugs/acetaminophen), with short-term opioids if necessary.
- For osteoporotic fractures, bone-density treatment may be considered (such as bisphosphonates).
- Appropriate antibiotics for open fractures.
- Rehabilitation and lifestyle management
- Early passive and active exercises to prevent joint stiffness (under the direction of a doctor or physical therapist).
- Exercises to maintain muscle strength in the immobilized area (moving joints that are able to move outside the immobilized area).
- Smoking cessation: Smoking delays bone union, so cessation is recommended.
- Psychological support: Excessive anxiety and fear can interfere with rehabilitation.
- Complications (precautions)
- Acute: Bleeding, shock, fat embolism, acute respiratory distress (ARDS), infection (in open fractures), and tetanus.
- Local: Nerve (including the radial nerve) and vascular injury, associated fractures (including accompanying distal radius or ulna fractures), transverse injury, and joint stiffness.
- Chronic: Nonunion, malunion, functional impairment, and chronic pain.
- Prognosis
- The prognosis varies depending on the patient’s age, fracture type and degree of displacement, associated injuries, and general condition. Good recovery can be expected with appropriate reduction, immobilization, and rehabilitation, but older adults and patients with pathological fractures have an increased risk of nonunion and complications.
Outpatient Visit Checklist (Including Preparation Items and Example Questions)
- Items to bring
- A list of currently used medications (including prescription and nonprescription medications)
- Previous test results and imaging materials (existing X-ray/CT images, if available)
- Allergy information (medications, latex, etc.)
- A record of recent symptom changes (pain severity, changes in sensation or movement, and when swelling changed)
- Details of the injury (when and how it occurred) and a history of infection and tetanus vaccinations
- Main items the medical staff will check during the outpatient visit
- Location and intensity of pain, presence of sensory abnormalities or movement impairment, skin condition (open wounds and injuries), and hand, wrist, and shoulder function
- Things to check before the outpatient visit
- Record the sensation (trembling and tingling) and ability to move the fingers, wrist, and arm
- Check for fever, wound discharge, and odor (signs of infection)
- Example questions for the patient to prepare
- The time symptoms began and their pattern of change (for example, when did the swelling begin to increase?)
- Whether there are underlying conditions such as osteoporosis or cancer
General Example Questions to Ask the Doctor
- What is the exact type of this fracture (for example, simple, comminuted, or involving the joint)?
- Is surgery necessary? If so, what are the expected surgical method and risks?
- How long is the average healing period? When can I expect to return to daily activities and work?
- What methods are available for pain control, and what are the side effects of the medications?
- What will the rehabilitation (physical therapy) plan be? What self-directed exercises can I do, and when can I start them?
- What are the signs of complications (such as nerve injury or nonunion), and in what situations should I come to the hospital immediately?
Examples of Disease-Specific Questions
- How displaced is the fracture on my X-ray (or CT)? Given its current condition, is conservative treatment (a cast/brace) sufficient, or is surgery recommended?
- There are findings suggesting an injury to a nerve, particularly the radial nerve. What is the likelihood of nerve recovery, and are additional treatments to promote recovery (such as electrical nerve therapy or a neurosurgical evaluation) necessary?