Closed treatment yields satisfactory outcome for most humeral fractures, specific situations do exist in which better results have been achieved through surgical stabilization.
Methods of Fixation
Compression Plating
This method involves fixing the fracture using a plate and screws. It is quite effective method of fracture fixation but involves quite significant amount of dissection and soft tissue stripping from the bone. and at itmes may cause blood loss.
The most common complications reported with plating procedures are infection and iatrogenic radial nerve palsy.Range of motion of the elbow and shoulder of the involved extremity returns predictably after plate fixation.
Intramedullary fixation
Intramedullary fixation involves passing a nail across the fracture sites. The intramedullary device could be a multiple, flexible devices or a single, more rigid nail, usually with interlocking capability.
External Fixation
Limited role in closed fractures. External fixation involves a system of pins and rods. The pins are passed insie the bone on either side of the fractures and held with connecting rods.
External fixation is used for open fractures and in case of damage control orthopaedics.
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Dear Dr Arun Pal Singh,
9 weeks ago I tripped and fell breaking my arm. It is my right arm. The doctors and radiologists have called it a comminuted, angulated spiral fracture to the proximal to mid humerus with butterfly fragment extension of fracture to the humeral head. Posteromedial angulation of distal portion. I am a 48 yr. old female. The doctor in charge of my case has me in a rigid, lightweight plastic brace composed of an anterior and posterior shell joined by straps. The accident happened on Mar 18th. Today is May 22nd. I was told right away that most breaks like mine are treated without surgery and that I would heal just fine without surgery. Below is a copy of the original x-rays as well as the last of my x-rays. It has been 9 weeks now and my break is just starting to get some formation between the open parts of the breaks. I am still in a good deal of pain at the break points, the head of humerus, my shoulder, the elbow joint and I also have pain and swelling down to my fingers and thumb. I am feeling like this is not working for me but the doctor is very ok with the angulation being at 18% because there is callus forming finally. Please look at the x-rays and just give me your opinion on what could have been done or what can still be done to possibly help me. I am feeling as though “not the best” is ok with the doctor I am seeing now. Yesterday he stated that he would see me again in 4-6 weeks and that he wants to continue treatment with the brace. He also stated that it looks like it may take up to 6 months for the fractures to mend. He does not explain why he doesn’t want to do surgery only that he thinks this is fine. He also does not know why I am experiencing pain still and cannot explain why I feel as though the bones are still moving around when I move certain ways. I ask about the swelling and he says it is from lack of movement and yet I am doing all the physical therapy instructed for my fingers, hand, elbow and shoulder. I do have radial palsy and have regained part of the use of fingers but my thumb is still not working right at all. I am feeling a lot of pain right at the head of humerus as well as where the break is angulated inward. I feel a burning sensation almost constantly along my whole arm and back of hand. I am right handed and so this injury has now kept me from going back to work and now it looks like I will be out for another 6 months at least. I also cannot function in my household any where near what I did before. I am not able to do simple things such as open cans with can opener, put my hair up in ponytail, fasten my bra without pain, get dressed easily without help, as well as many other things. I cannot enjoy life at all when all I can think about is hurting and waking up all night long in pain. I do not want heavy duty drugs at all. I just want it to heal properly and as quickly as possible. It is 4:45 am and I went to bed shortly after midnight. I have taken one Darvocet and it hasn’t helped at all. I finally decided that laying in bed crying was doing no good and came to the Internet to do some research. I do have an appointment for Monday morning with a doctor outside of military hospital for a second opinion on what can be done at this point. Anything that you could share with me would be helpful. Thank you for your time.
Sincerely,
Mrs. Beach
Dr Arun Pal Singh Reply:
May 26th, 2010 at 11:40 pm
@Lelalu Beach,
I could not find any link to xray.
18 degree angulation is acceptable by medical standards in case of humerus as the movements are very well compensated by shoulder.
It is a good thing that your fracture is throwing callus. Your doctor is right to state that most of these fractures are treated by non operative methods.
If your fracture is healing the best course of action is to let it heal.
I can understand your agony and your concern about the treatment but with the provided information, I think you are being treated right.