Non Union In Fracture of Shaft of Humerus

Fracture of shaft of humerus is very amenable to treatment but a percentage of fractures do not heal. Normal healing of a humeral fracture occurs over 8 to 10 weeks. If the fracture has not achieved union by 3 to 4 months, it can be considered a delayed union. If union does not occur by 6 to 8 months it is called non union of the fracture.

Non unions are two types

  • Hypertrophic
  • Atrophic

Hypertrohic occurs due to increased vascularity which allows abundant callus to form. The callus formed has insufficient stability to prevents union.

In atrophic non unions, the fracture has inadequate blood supply and prevents callus.

Operative treatment methods have higher rate of non union as compared to non operative method. Apart from this there are various factors that increase the chance whether a patient would develop non union. These factors are

  • Inadequate immobilization
  • Distraction at the fracture site resulting in a gap between fractured surfaces
  • Energy of the injury
  • Open fractures

Treatment

Treatment of the non union aims at removal of the cause if known, fixation of the fracture with surgery and bone grafting to augment the healing process.

The bone can be fixed by plating or intramedullary nailing. The graft is usually taken from iliac crest.

In caes of non union and osteoporosis, it might be difficult to attain the fixation. In such cases an additional procedure like filling he cabity with cement or augumentation with fibula may be needed

Incoming search terms:

  • non union of humerus bone (3)
  • surgery on non-union humerus fracture (3)
  • severe pain from titanium plate in humerus (2)
  • has anyone had humorous bone mid shaft broken and suffered non union? (2)
  • humerus shaft callus (2)
  • how long for humerus fractured shaft to union (2)
  • if the bone fracture in humerus did not unite for 7 months what would the ortho will do? (2)
  • non union humerus at 6 months with no pain (2)
  • normal not to join humerous fracture bones together (2)
  • non union fracture humerus (2)

Comments

  1. aman says

    4 months back i had an accident in which my arm bone got broken so i had consulted many doctors they all said that plate surgery wud be required so after couple of days i went-off for a surgery and after that doc. told me to keep the plaster for a month(not to take any risk)after a month they said the bone has started healing so he removed it and told me to come for physiotherepy and after few days i started moving my hand it was completely no pain but i didnt know i wud have to suffer a lot of pain after it and i met doctor after it they had my x ray and it shows the mis alignment i completly shocked to see the plate is coming out of the bone so he told me to keep a belt on ur arm for few wek as i did tht. after it i got my plate back into the bone and he told me to keep the plaster again,i did that but healing doesnt work i met some doctors now each have thier different opinion someone says that bone grafting wud be needed someone says it is due to infection and another says to wait 4 some more time but i know how painful it is n i feels very dependent what steps i should take now?

  2. Dr Arun Pal Singh says

    @aman,

    You did not mention which bone it was but I presume it is humerus.

    Could you mail me an xray.

  3. Tapojoy says

    Hi Sir

    I had a fracture on my shaft of humerus, left arm. An xray was taken after after 2 months of operation (plate and screws), the gap was seen to be filling. The doc advised me to start straightening my arm. I use a plastic arm support. After one more month, the xray showed the gap was back again with the bridge bones missing. The plates havent changed shape. Its been total 3 months now. I also have lecithin and minoxidil simultaneously. There was also an incident where my hand got jerked recently when i was not wearing the plastic support. There is still pain when the spot is pressed. Please suggest steps i should take. Are there any electronic stimulators? What could be the reason of this reappearence of gap.

    Tapojoy

  4. Dr Arun Pal Singh says

    @Tapojoy,

    Ultrasonic stimulators are available but the effectiveness has varied and would depend on the gap between the fracture fragments.

  5. aman says

    i hav a humerous fracture left arm near bicep so healing is very slow what precautions i should take and which is the best medicine or powder for calcium and give me some tips that how healing can occur quickly

  6. Dr Arun Pal Singh says

    @aman,
    You should eat good diet and follow your treating doctor's advice.

    Calcium is only of less significance and quest for the best will not yeild anything.

  7. stuart says

    Hi I have found this article very helpful I am basically looking for evidence that sometimes these processes do take place. I had/have a complex spiral fracture of the tib, and the op of the tib was snapped off and in half vertically, the operation was delayed by two weeks due to cast blisters over my whole lower leg, then I was readmitted with an infection actually 4 now, I have had 10 or so wash out operations over 5 weeks and now a plastics operation of a skin flap over the metal work and skin grafts now over the calf and shin, and I have had another x ray showing "no evidence of bone union" I have a metal plate running the length of my leg and about 14 screws, 5 holding my knee together the rest running down the tib. this has nearly been 3 months since the original accident. I am hoping that the reason for the lack of bone union is the repeated operations. The medical staff still appear upbeat about it whereas I am getting paranoid that they will remove my leg. The infections include pseudo monas which has become resistant to both cypro and gentamysin and is now being treated with tazocin.

    I assume everything is as good as it could be in the circumstances.

    Thanks for any input or advice

  8. Dr Arun Pal Singh says

    @stuart,

    Non union is a problem and infected non union is a bigger problem. But both can be managed with proper treatment.

    In case of infected non union, the idea is to eliminate the infection first and then stimulate the bone healing.

    I think you are on right track. Please do keep me posted.

  9. Joan says

    I broke my humerus (mid-shaft) in April. and at first they said they were going to operate but then decided to send me home with an airplane cast. My follow-up ortho removed the cast a week later and put on a brace, but 10 weeks later he said it wasn't healing and recommended ORIF. He put in a plate and pins that extend the lenght of my humerus. Since my surgery I have had shoulder pain, and now 8 weeks after surgery I still can not extend my arm to the side more than 30 degrees without my entire shoulder raising 3 to 4 inches abnormally in comparison to my good arm. I am experiencing pain in my should and across my back and neck. PT does not seem to be helping. What should I do?

  10. Dr Arun Pal Singh says

    @Joan,

    What is status of bone union? What did your doctor suggest?

    Prolonged immobilization lead to joint stiffness that is generally amenable to PT.

    But we must ensure that fracture has united.

  11. victoria says

    i had an accident in 2009 and broke my left heumerus bone and it resulted to non union which was operated 0n 6 june 2010 but after gotten my xray it was not healing properly and i was put on cast for 2months but still it looks like its not uniting wot do u suggest i do.

  12. Colm says

    Im a 39 year old non smoking male and I broke my left humerus 25th December 2009 very badly and was operated on 27th December and a 10 inch plesae was attached with 3 screws below and above the sight of the break with no cast put on my arm. I had it in a sling for approximatley 8 weeks before being told it was ok to to take it out. Since then I have been back to my doctor numerous times and as of today 4th October 2010 it still has not heald!!! I have done plenty of physio and have regained 90+% of movment back in my arm and have used ultrasound bone stimulator from appox end of May to mid August which has promoted the start of a calus, however this has not healed the break sight!!!! I have been told to give it more time but at this stage its almost 10 months and I have finally lost all my patience with this. What course of action is available to me at this stage? My doctor does not want to do a bone graft as he says as the calus has started to let this take its course however I think at this stage will it ever heal by it self???

  13. Russell says

    Hi i had a spiral fracture break on my left humerus bone about 5 years ago. I had the choice of letting it heal with a arm cast or have a titanium plate screwed to the outside of my bone. Being worried that it wouldn't heal right with the cast i chose to have the plate installed. I had x-rays taken before the plate was installed after it was screwed in, and then again about 6 months after the incident. The break was pretty bad and after the x-rays were taken 6 months later you cant even see on the x-ray where the bone was fractured just the plate and screws. The only problem with the surgery is i have bad nerve damage and my bone still really hurts when i do any kind of physical labor which is really a problem especially when i exercise. Before i broke the bone i could bench 250 lbs no problem and now i have a hard time with a 100 lbs from the pain. So my question is this, is my arm hurting because the plate is keeping my bone from flexing where the plate is, so the bone on either side of the plate is doing all the flexing? I am contemplating whether or not to get the plate removed. Would this be a good ideato get it removed and is it possible that the plate is what is causing my pain?

  14. John Kavanagh says

    I suffered a mid-shaft transverse humerus frac 9 months ago. After initial plaster and decision not to operate,I eventually had ORIF treatment 6 wks after frac.Subsequently started physio for -3 mths.after suffering much pain,blood tests revealed high level of infection/Started on 6 week course of Fucidin and Flucloxacillin.At end of course,infect returned.Also,xrays revealed that 4 of 8 screws of ORIF are leaving bone.I am 69 yrs old and am now awaiting surgery in 3 weeks. I have non-union of the fract.I have been using Exogen ultrasound treatment for 80 days to no avail

  15. Dr Arun Pal Singh says

    @Colm,

    Could you please mail me images of your xrays from first to the latest.

    Let me have a look.

  16. Dr Arun Pal Singh says

    @Russell,

    You mentioned nerve damage but did not elaborate. What was the nerve and what are the problem caused by that damage?

  17. Russell says

    Hi Dr im not exactly what nerve it was, the Dr that did the surgery described it as the nerve that makes my hand move up and down i know thats vague but that nerve was caught between the bone so pretty much my whole arm has bad nerve damage. If i even barely get scratched it feels like my skin had just been pinched really hard and over the years i have just got more used to it. But still i feel like if i get my plate removed it will at least stop the pain on my bone because thats what keeps me from doing some work and exercise. Im only 23 so if i can do anything to help my bone get better now i want to be able to do it rather then wait 15 or 20 years. Do you think removing the plate is what is making my arm hurt when i am lifting heavy things?

  18. John Kavanagh says

    Following up on my email dated 15th Oct, there are 2 surgical options given by 2 different surgeons as follows 1. To remove plate, debride the bone and tissue,take sample and identif type of infection and treat.Close and stabilise arm and start new ultra sound treatment.after 2 to 3 mts ,,ifthere is no union,carry out ne ORIF.2nd Option-Similar to above but this surgeon planned to carry out new ORIF after removing failed fixture and debridement.Comment-I am a bit concerned with 2nd option in case infection should return and am requesting your kind opinion as to bestoption

  19. Dr Arun Pal Singh says

    @Russell,

    If you think plate as the cause, discuss it with a doctor in person.

    He would be able to advise you better. How is your nerve deficit. What treatment did you get for that?

  20. pawan singh says

    i have broken my left humers bone on 16 aug 2010 and got operated on 17 aug . as doctor said me there was bone loss and he done a small bone grafting and bones are supported by plates. after 10 weeks there is still gap in my bones . doctor is suggesting a bone grafting . so ls. suggest wether i should wait for some more time or i should opt for bone grafting. ? is there is any other technique available for fillling up bones gap.

  21. Dr Arun Pal Singh says

    @John Kavanagh,

    It is of utmost importance the treat the infection first before putting the implant inside.

  22. stuart says

    still got a few issues these are 6 week old xrays

    Edit: Image URL Removed For Privacy issues.

    I am no antibiotics at present after renal failure in mid august, and have been at home since September, the ortho consultant and infectious diseases consultant think that my wife is giving me antibiotics crushed in my food as touchwood I have not been ill, and the last scab is starting to heal. I can walk on it 10 meters or so, and my physio is sure that there must be bone union otherwise the metal would rip through the skin on my knee and out the bottom where the lower 3 screws pull out of my tib.

    when I got these xrays I asked the operator to look at them and he initially said that is where your infection is pointing at the split near the knee, I exaplined that I was told I dont have an infection and then he said I would need to discuss my xrays with my consultant.?

    also on my last visit the consultant said to me "there is no obvious evidence of a bad infection" what on earth does that mean?

    thanks

  23. Anne says

    I broke my humerous about 4 inches below the shoulder in 1/2. July 2009, they placed a tintanium rod. Bone never healed and I complained of shoulder pain. The MRI showed that the titanaium rod was placed a littled to high and was rubbing against my shoulder. So June 2010, I had the tintanium rod removed and a plate with 8 screws placed and they did a synthentic bone graph using my red blood cells. I had been sleeping on the couch, arm was not to painful, but I noticed when i woke up October 10th that my arm was very uncomfortable and I could feel the clicking of the bones again. When I went to the doctors he told me it was worse and may have to do sugery again, but this time use my own bone for the bone graph. So this will be my 3rd surgery. He diagnosted me as nonunion. He also recommended that I try a bone stimulator so i am waitng for the representative to call me. Just wondering if you had any other ideas. I really do not want to go through another surgery, but i cannot stand that my arm is useless.

  24. Anne says

    PS not sure I can get my hands on an exray. There is a visible gap thought and I was wondering if may it was too far apart to even heal.

  25. Dr Arun Pal Singh says

    @pawan singh,

    If the gap is too big to be bridged it needs to be grafted. But if the gap is too big then your bone fragments also need to come in contact by some or other means.

    You can discuss that with your doctor.

    No! There is no other technique.

    Not till now.

  26. Dr Arun Pal Singh says

    @Anne,

    A non union is best treated by surgery and bone graft, but before you undergo another operation, it is very important to determine why did previous implant fail.

    Your bone did not unite in spite of being grafted.
    Why?

    A stimulator, in my view, does not work in established non unions.

    Moreover, the results are better in bones which are superficial, such as tibia.

    But your doctor would be in a better position to give you appropriate advice.

  27. Dr Arun Pal Singh says

    @Anne,

    An xray would give a better idea of what is happening. Still, it is ok if you cannot get them.

  28. stuart says

    Sorry I dont have any actual xrays just the recording from my phone in the xray room, I will need to pay for them at some point. The external cut is just about healed now, the leg still swells up during the day and drains again at nighttime when it is raised.

    I am back on tuesday so hopefully they will have some good news, although I reiterate I was told it will take at least a year to heal.

    Thanks

    Stuart

  29. stuart says

    Hi yes I have most likely had about 150 xrays in total since may 16th when I got knocked off my motorbike. the last 2 were by a different xray machine which used no plates and took two pictures and stuck them together the pictures were much clearer. my bloods are still normal inflamatory wise, I only have a tiny bit of dry flakyness on the difficult scab. but my xrays still show "no significant sign of bone growth" and I have now been told to do much more load bearing as my femur is disintegrating "osteopenia" apparently. I have been assured that the femur is not infected and even if I still have osteomylitous in my tibia it will grow.

    a question I still have is whether it is possible to still have pseudomonas infection but show no signs of illness, pain, blood inflamatories.

    I can stand and walk using the metal to hold the broken bone together, I can even stand on that leg and feel like I am improving everyday, In my physio which is still every week she is trying to free up my foot and tells me that everything is getting better every week. I can straighten up to about 14 degrees and bend to about 115 degrees.

    I have also had 4 or 5 CT scans, they were mentioning an MRI scan but I was recovering from renel failure at the time and would not cope with the pigment.

    Thanks for your reply

  30. Anne says

    I have been x-rayed again and no I did not get a copy…I was too in shock. The Doctor said is was worse then when he started. The bones has actually seperated more. So he recommends another surgery, this time using bone graph off my lower back (last surgery he used synthetic bone graph). This will be my 3rd surgery. (Will I be able to keep my job, jeez that is another worry.) So I am going to get a second opinion. This is getting rediculous. Wouldn't you think he should order some tests, try to find out why my body is not healing properly. I am almost to the point where I will just have to live with a bum arm. I mean he was happy with the progress 1 month after surgery, now it is worse then when he started? I have not fallen…I have used the arm carefully. I kniow something in my sleep happended, cause I woke up one morning and I knew something was wrong with it.

    My mom thinks it is the after care. (She is a nurse). She cannot believe that the arm is not put in a restraint which prevents me from using it for at least 7 weeks in order to let the bone heal. I was told to let the arm move freely. Well now it is out of joint (at least that is the way it feels.)

    I am going for a second opinion.

  31. Anne says

    I spoke to a friend of mine who works for an orthopedic surgeon and this is his take:

    1. Never should have used a rod, limits the amount of blood to the break.

    2. Second surgery should have used my own bone graph and not a synthetic.

    He referred me to a trauma bone specialist for a second opinion.

    So i am waiting for a response from them to make an appointment.

  32. Dr Arun Pal Singh says

    @stuart,

    It is unlikely to have a frank infection without signs but you need to watch.

    All the best.

  33. stuart says

    @Anne Listen I am not a doctor but everyone has their opinions from things they have seen during their experiences in hospitals from the nurses, health care assistants,cleaners to like me even the patient, . they are all willing to give you advice. It gets even worse once you have 3 or 4 departments arguing over your health, care and treatment.

    I spent 4 and half months in hospital because of my break + infection + plastic surgery + renel failure.

    Sometimes they say dont load bare, load bare more. The consultants even have their own opinion some breaks need to be left some breaks need to be active. You mum may have been right for the 7 weeks wait but only in certain circumstances, if your arm was left without movement after 7 weeks they would be cutting out bits of your shoulder as you would have got a frozen shoulder (that is painful someone next to me had it done).

    try to trust in the consultants (It takes quote a few years to become one, and their registrars and sho's will do everything the consultant advises even if they dont qwuite believe it themselves), if it was plated the bone doesn't know to grow to each other as their is no friction on the break, which is why sometimes they try ultrasound / magnets etc.

    I am not sure that bone grafts work on established non union as if it is not growing at all it will not grow onto the bone graft, and if it is plated and the plate is still in place then they will be reluctant to remove it.

    ———————–

    I checked all the sites for what to eat etc to help bones grow, and I am still unsure about the hypertension pills they put me on as they are called "calcium channel blockers" but my consultant has simply said "no anti inflammatories and no smoking." but he did put me on diclafenic for the first 4 months until my kidnies packed up. go figure.

    Do you mind me asking what hospital you attend?

  34. stuart says

    oh balls, I feel a little ill my shin hurts spoke to GP and my blood tests show CRP 64 and ESR only 1, white blood cells normal, I am having another blood test tomorrow if the CRP are still high I am back in hospital for a white blood cell scan to try and see if it is the bone infection or just a cold etc as my son has flu. fingers crossed it is just a cold.

    This is a real shame just before christmas, but pseudomonas does have a habit of sleeping on the metal during antibiotics then coming back to life, if my shin didn't burn so I would take no notice but it feels wrong.

  35. Debbie uyetake says

    HI broke my humerus bone in half mid way in early november a surgery was done with a plate form elbow to the rotator cuff One screw in the top next rotator cuff and on down by my elbow. One Dr. says keep it in a sling do not use the other says do not wear a sling and get into therapy. The first Dr. who did it wants to do surgery and take the the screw in the top out because it has backed itself out some and causeing pain the bone has not closed in yet. the whole plate hurts it rolls over the joint on both the elbo and the shoulder . The other DR. says do not take it out. Does this kind of surgery stay in forever. and will it quit grindding on the joints. Is it best to have the medal out latter

  36. Dr Arun Pal Singh says

    @Debbie uyetake,

    What you describe fits more inn description of nail rather than plate.

    Can I have a look at the xrays.

  37. Kyle says

    On 4/10/2010 I had a severe motorcycle wreck in which my body stuck a pole at 70mph which led to a displaced transverse fracture of my humeral mid-shaft. After a little over 3 months of no healing orif was don with a locking compression plate on 7/29/2010. Had used a bone graph from my left illiac crest and a smith and nephew bone stimulator. Things were going good up untill my x-rays on 12/13/10 that showed my plate pulled off the top screw and my arm was now bent- not to mention the pain was also increasing and I was loosing ROM. Now I have no idea what to do and I don't have enough $$$$ for another surgery. (no-insurance)

  38. Dr Arun Pal Singh says

    @Kyle,

    Need to see your xray,
    1. After the injury
    2. After the surgery
    3. Present xrays

    Can you send them to contact [at] boneandspine [dot] com

  39. archanareddy says

    hi doctor my mother had fracture shaft humerus 3 mnths back.she had hysterectomy 9 yrs back.2 x rays were taken til now.last one at 2 mnths fracture which shows just started healing.doc said its due to osteoporosis.doc had adviced to take ultrasound therapy.wil it be useful?plz reply me

  40. Dr Arun Pal Singh says

    @archanareddy,

    Role of ultrasound stimulation is not as clearly established in shaft humerus as it is in tibia but I do not think there is any harm in trying that.

  41. archanareddy says

    what other methods can i help my mother to get her fracture unite.its already 3 mnths finished.she is using ultracet for pain.she is also having pain in the shoulder from 1st day itself.y shoulder pain occurs for fracture humerus.i had finished mbbs and trying for pg

  42. Abdi says

    Hi Dr.

    I fall on a tarmac or concrete floor while kicking a ball as floor was slippery on 11th April. I had a clean fracture of my left humerus bone. The doctors recommended a non-surgery treatment and informed me after reviewing x-rays. I saw a private consultant for a sseconf opinion after feeling lots of pain on the start of my 5th week. The private consultant agreed with the drs treating me to leave fracture to heal itself so as to avoid damaging the radial nerves and the fact that its a clean break in the middle of the humerus bone. He also said that humerus fractures take longer to heal.

    I have xrays every secong week and its still not aligned properly. The two bone are touching each other by just 30-35%. I have been sleeping on a recliner chair and even so was painful and sleeping sometimes just one hour.

    I have been eating well, lots of calcium. I still have lots of pain when sleeping even on my recliner chair and when I wake up. Sometimes I hear movements of the fracture bones especially when i wake up from my recliner chair or try to stand if I was sitting and its painful at these times.

    I will appreciate if you could please answer me the following questions if possible:

    1. Is there any way of aligning this fracture with out an operation as I fear the two bones will not heal quickly especially if they are not aligned. I have tried hard to limit my movement and when i move i can hear movement in the fracture and this is followed by pain @ the fracture.

    2. In my last xray two weeks ago, there were small callus visible and drs said it will be more clearer in the next xray. Will callus be formed on unstable fracture? If the bone has moved since the last fracture, what happens to the small callus that are been formed? Does these movement delay it even further? I have emailed you one of my last xrays for your opinion.

    3. What is the average healing duration of a a fracture similar to this one? I know that we all dont have same healing duration but an average is all i am looking for.

    4. I suffer lack of good sleep – does it have an effect on the healing process?

    I will appreciate if you could advise me further on how best to speed this healing.

    Many thanks

  43. Jenny says

    I had a car accident 10 months ago I fractured my femural head and broke my femoral shaft into 3 pieces. The femoral head healed but the shaft isn't. My doctor said the X-ray looks like I just had my surgery yesterday. I'm 35 years old, don't drink, don't smoke. I take all kinds of vitamins I've been using bone growth stimulator for 5 months now. My doctor said I need a second operation remove the metal plate and screws and replace it with rod. I really don't want another operation. Can't afford it and I don't want to experience the pain again. What are the other options? Beside operation. Hyperbaric treatment is also very expensive. Doc, your opinion is very much appreciated.thank you waiting for your response.

  44. Dr Arun Pal Singh says

    @Abdi,

    1. Perfect alignment is the goal of treatment but rarely achievable with non operative treatment. Therefore if your alignment is within acceptable range, it is ok.

    Union would happen, if it has to happen, without alignment too. This applies to a range of alignment in reduced fractures and not applicable in displaced fractures.

    2. Small amount of movements or micro movements actually enhance callus. If there is total immobilization as in plating, the caluus does not form.

    Larger movements are detrimental to callus.

    3. 6-8 weeks, can take up to three months
    4. There is no direct studied link but lack of sleep is a stress and in theory at least, stress has negative effect.

    If there is anything more, please let me know.

  45. Abdi says

    Many thanks Dr for your reply. It's now 2 complete months and I still feel pain at the fracture site especially at night. I have now been sent a physiotherapy appointment, which is in 2 weeks time. I am 36 yrs old, healthy person with no other ailments and do no drink or smoke. Below are 3 more questions I have:

    1. I have pain also around the Clavicle or the Scapula bone and thought of requesting for an xray around my shoulder just in case there are other fracture falling my fall on my left side. Drs saw the humerus fracture only at the time. When I asked once before, one of the Drs said it may be because of the pressure from the brace or the sling or as the result of sleeping on my right side. Do you think I should request for an xray on the who of my left shoulder to check if there are other damages?

    2. It's now 2 complete months. Sometimes when at home and I am not in pain, I take out the brace and everything else like the arm immobiliser and try to move my arm. I found out that my arm only stretches for upto 140 degrees. It's painful to go any further? I was advised not to force it but I am also concerned it may never be straight? What do you suggest that I do on this please? Is it because of my humerus healing at angle instead of straight? I can see from outside that my humerus is bending at the centre.

    Many thanks for your advice.

  46. Dr Arun Pal Singh says

    @Jenny,

    10 months old ununited fracture is a non union and would be treated on lines of that.

    While I cannot comment on surgical decision made by your doctor, all I would say is that surgical treatment is necessary in non unions and still is the gold standard.

  47. Dr Arun Pal Singh says

    @Abdi,

    1. If the pain is significant as judged by your clinician, getting an xray is not a big issue. Its a small inexpensive investigation that makes things clear and would address your apprehension. But the final decision has to lie with your clinician.

    2. Most likely it is because of long standing position in plaster. If it is so, it would take some time and improve as you exercise.

    I hope that helps.

  48. puneet says

    Hi Doctor,

    I had a broken humerus bone( mid-shaft) due to arm-wrestling. It was the non- dominant arm. I had a surgery within 2 hours and plates and screws have been inserted. Post-surgery, the x-ray report was good.

    At present 1 month after the surgery, I am still on sling ( doctor has advised to keep it for 6 weeks), but I remove it quite often. There is a marked improvement on the range of motion and my hand gets almost straight.

    I have 2 querries:

    1) Is it advisable to do do PT?

    2) I dont want to keep the plates inserted in my body throughout my life. My doctor has said that he will remove it after 6 months- 1 year. So, is it safe to remove the plates. Are there any complications involved. Do I need to take ant precautions for it..

  49. Emm says

    Hi Dr,

    I broke my left humerus (mid shaft spiral) Dec 25th 2010 and was initially told it was a clean break and 6-8 weeks ill be close to good as new, but it is now 6+months later and the bone is still broken. with each new x-ray (apprx 4-5 weeks in between) there shows a very very slight bone growth on part of the break and none on the rest of it. I have already been to see 2 other doctors for opinions a couple of months ago and each said "it looks fine – you need to be patient" I dont smoke, eat relatively healthy, take my vitamins most days, wear a brace, use the exogen bone stimulator daily and try not to do anything to strenuous. I had blood work come back all normal except a bit low on vitamin D. We already cut down on the PT as there is not much more to do without the bone healed. The pain comes and goes but is a non-issue the majority of the time, – except when its humid or if i move around too much, sleep funny etc…. At this point I find it hard to believe that just being patient is the answer – Do you have any recommendations?

    Thanks

  50. Dr Arun Pal Singh says

    @puneet,

    First goal is bone union and achieving range of motion. Please ask your concerned doctor if it is time to do PT.

    Plates can be removed after sufficient remodeling has occurred and that is around one year of time.

    It would require almost a similar surgery of almost same magnitude.

  51. Dr James B says

    My nephew, 24 yr old – 5'9", 142lbs, involved in a MV accident August 10th 2010. Observed by surgeon 4 days later with left mid-third distal transverse humerus fracture. Additional radial nerve palsy. Patient has drug addcition history and should avoid opiates. At time of surgery on Suboxone. Other systems unremarkable for GI, endocrine and cardio. Shows wrist drop and loss of digital extension. Fracture showed butterfly fragment, opposed 30%. Surgeon advised outpatient surgery (very questionable from my standpoint based on his history of pain meds). Plating suggested up the back of the humrerud; as opposed to intermedullary rod -to maintain shoulder function/mobility. Observe radial nerve for compression or confusion. Patient operated on; direct posterior approach in the interval between lateral and long head of triceps. Radial nerve anatomically within fracture site. confused but intact. once removed, it pinked up. Fracture site cleaned up and set with an 8 hole broad plate. Regular and lcoking screws used. Cancellous bone chips and bone matrix were packed in the gap. Fat graft ws taken from lateral arm and fixated and the radial nerve relaeased. Pateint was in great pain after recovery and unfortunately placed on morphine derivatives. a gross error; instead of analgesics. Follow up: radial nerve palsy ceasaed after 7 months. Some numbness remains. 10 moths after a 1-2cm mass is noted above plating through bicep. Taken to Ortho for investigation. Raiographs show mass eminating from calcification on plate. However, worse case scenario also noted, i.e., Non-union of humerus fracture. Cause unknown. In addition fracture of 8th anterion screw head; and windshied effect of all non-locking remaining screws. Suggested bone graft procedure stat.. Concerned with need for post operative inpatient stay needs on analgesics as opposed to return to opiods. Patient has "turned his life around" lately working full time on a horse farm. Remains on suboxone. Is in good spirits Please advise.

  52. Dr Arun Pal Singh says

    @Emm,

    Can I see your xrays! You can send them to contact [at] boneandspine [dot] com.

  53. Shakti Aggarwal says

    Hello Sir,

    I had surgery of humerus, plates and screws have been inserted on 14 April 2010.It was displaced fracture (bone was broken completely and displaced) and titanium plate was used to to join both bones. Post-surgery x-ray report was good.

    On 25 July 2010 I had X-ray and bone is still not joined and on one side callus formation is there. It could be on side of non union. What should be my next step? Can this callus do secondary union? My doctor asked me to wait for some more time

    Thanks

    Shakt Aggarwal

  54. Dr Arun Pal Singh says

    @Dr James B,

    In established nonunion one would almost always require bone graft. However, I would like to have a look at xray.

    Would you please send it to contact [at] boneandspine [dot] com

  55. Dr Arun Pal Singh says

    @Shakti Aggarwal,

    The callus is generally not seen in plated bones. it is advisable to wait and watch.

  56. Roberto says

    Hi Dr.

    I broke my humerus bone halfway in a car accident on August 21st of 2010. Had surgery the following day and got a plate with 14 screw on it. Had radial nerve damage but it healed completely. The only thing that didn't heal was the bone. It's about half healed. It started healing on the 4th month, then it stopped, started again and now appears to have stopped. I did an electrical shock therapy 3 months ago which seemed to help a little. My doctor just says to wait a few more months but I am worried because it's been 1 year already. I don't have any pain, have full motion in my arm and hand and I have started lifting small weights also with no pain. What should I do?

  57. Dr Arun Pal Singh says

    @Roberto,

    If the bone is not united, your implant bears all stress and would fatigue soon.

    In such cases, bone grafting to stimulate union is desired.

  58. dechen says

    helo sir
    My father is 50 years old …..he met with an accident in march n broke his humerus ….there was also a gap coz some part of bone was meshed…..then he got orif done …..though its been september now the gap hasnt filled or formed ……almost 49 weeks though he still can move or can say theres improvemnt in movement…..but the gap is still concern ….he’also cant cmpletely fex or straightn his hand….

  59. Jean Gehlken says

    I am a 78 year old female. I fell and broke my left humerus three weeks ago. I have been wearing a "clamshell" brace for the past week. The top of my left hand is purple in color and formed a very large blister. The blister is about the size and shape of one half of a baseball. Additionally, many small blisters have formed along my forearm. My forearm is discolored to the degree of appearing as a very deep suntan. Constant exerecise seems to cause the blister to decrease in size, and refill within an hour. The sight of this condition is very scary to me. However, my doctor ensures me that all is well. I would appreciate your comment on my condition. Thank you very much.

  60. rushyendra says

    hi i got left humerus fracture on 15th of November and undergone humerus plating operation on 16th november was in hospital till 21st and came home and gone to hospital on 1st dec on that day doctor removed my stitches and again kept a plasterof paris support bandage with arm bag and told that i need a month more rest for my hand and then on 30th dec he will take an xray and if bone is joining he will remove the bandage.my question is i do have smoking habit 1 or 2 previously and i started to smoke once in a day from 28th nov onwards does it effect callus formation.

  61. Leo says

    Hi,

    I suffered a Distal humerus fracture on 1st August 2011 falling down stairs. It was a spiral fracture and fractured in several places. The injury I was told was quite severe and surgery was the best course of action. As i recall, the fracture was very close to the nerve which the doctors were concerned about prior to the operation. I was alarmed to find out my operation took 8 hours to fit a plate and 10 screws. The plate runs up most of my humerus bone.

    I was in hospital for a week before any surgery in which time I was put in a temporary cast when I entered hospital and then put in a specially made arm brace that was made according to the size of my arm. This brace had 2 sections to it. Upper arm and lower arm with a metal hinge holding the 2 parts together. This same brace was used following my surgery. My arm was immobilised for several months in the brace and sling before the consultant advised he was happy for me to take it off. Even now, I wear it at night as I worry about rolling on to my bad arm during the night.

    I have had physio for the last few months now just to get the arm moving again but when I last saw my consultant nearly 3 months ago he did not want any strengthening exercises to be done just yet. I hope this will change when I next see him as my muscles are very weak from non use.

    I have only just returned to my office job on limit duties….no carrying files etc.

    Whilst I do have use of my bad arm I continue to suffer with severe stiffness in my elbow and frequent aches and a general heaviness in my upper arm. Some days are better than others, some days it gets progressively worse. Some days I wake with aches in my arm, some days I do not. I always have a stiff feeling in my elbow regardless.

    My arm will not extend to fully straight. The lag was 35 degrees but through physio it has reduced to between 12 and 16 degrees. This angle seems to be the limit of improvement which is not a major problem to me although not exactly ideal either. The other problem I have is I still do not have full movement of my arm when I bend it. At a push I can bend my arm to 120 degrees. Again, this is an improvement but not great for me as sometimes I find it hard to eat using that arm as I approach the limit of the movement I currently have.

    I am getting concerned and to a certain extent depressed that this is it in terms of range of movement/lag etc. All my problems seem to centre around the elbow joint which upsets me as this was not damaged by the injury. I find myself holding my arm slightly higher than if i left it by my side or putting it in my pocket for support although physio have told me off for doing this and i shold not worry aout having my arm down by my side.I had full range of movement prior to the injury.

    Although I can accept the limited range of movement it is the continued aches and stiffness that is really starting to get me down. Are these aches and stiffness normal considering the timescales? Will I have to put up with these aches for the rest of my life? I am starting to worry.

    The fracture site remains very sore to touch. Is this normal?

    From what I understand from the X-rays all is remaining in place with the implants but it seems the union of the bone is perhaps a bit on the slow side although a slight whitening of the fracture could be seen when comparing X-rays but I get the impression this should be happening quicker hence why I am still not cleared to strengthen the arm.

    If non union does happen what will happen to my arm in the long term? I'm starting to freak out as most of it is perfectly fine I.e hand, wrist are fine.

    I think most of my questions are embedded in my post above but I guess what I am Also asking is does this sound normal in terms of progress, abnormal and so on?

  62. Leo says

    Sorry, forgot to add, I am 32 years old, male and otherwise in good health. Non smoker.

    I should add, the consultant thinks my aches pains in my upper arm are muscular when I asked him 3 months ago. Should this still be the case even now? Elbow, he has not mentioned much except to say he wants to see more movement in it so when I next see him I can only imagine he will not be best pleased with next to no more progress.

    Thank you very much for taking time to read my main post and I hope to hear from you soon.

  63. Dr Arun Pal Singh says

    @Leo,

    One of the purposes of surgery is to provide secure fixation so that adjacent joints can be put into early motion without waiting for bony union and then beginning the process of joint motion.

    If not done early, the joints become stiff.

    I am not sure why your arm was immobilized in a brace for several months. It could be that your fixation was not strong enough. It could happen despite the best efforts.

    Bony union on xray is the point where we can start strengthening the limb gradually.

    You need to be sure if your fracture has united. A latest xray would help to find that.

    Ask your doctor if bone has united or not. It could be difficult task for the naive eyes to guess if the fracture union is present on a give radiograph.

    Let me know. If possible you can send an xay using the email address at contact page.

  64. Aravind says

    Hi ,

    I had a mid shaft humerus fracture 5 months back and the fracture was fixed with plates and 3 screws . For one month , I had my hand on a sling but removed it after that on the advice of the doctor . I check it recently but the Xray showed that the union had not yet occurred . The doctor said that we could wait for couple more months and I could continue without extra medication or sling till then .

    My question is whether I should keep my arm completely immobilized for two months as I feel the recovery might be getting affected since I don't have my sling on . The doctor had prescribed me some exercises like bending my elbow , bending the elbow and moving the arm in a round arc etc which has helped me in maintaining my movement . Could these exercises be a cause for non union .

    Also , since the injury is classified as a case of delayed union , should I worry about a case of non union since it's already 5 months old ?

    I am a non smoker and non alcoholic . The shoulder and arm movements have returned to 85% . I have a slight weakness in my arm – everything else seems fine .

  65. linda says

    I broke my right humerus 3.5 months ago.. the break started just below the humerus head and spirals almost completely down the humerus with a displacement of about 40 degrees. They put a weighted case on the forearm for 1 week to pull back into alighment and immobilized it with a sling for 2 months. The calcification was starting but not very strong and the bone still appeared slightly displaced but my dr was not concerned about that. He allowed me to start phyiscal therapy (my shoulder and elbow were frozen after the immobilzation) and motion is finally returning to both joints very slowly. Both the dr and the PT have indicated complete healing will take ~1 year. I see my Dr again next week for an Xray. I am only concered about one thing. I keep having this pop with severe pain and what feels like bone movement in my upper bicep near my shoulder and at the location of displaced part of the fracture. To me, it feels similar in movement to when I first broke the bone. The pain is not constant but only happens quickly and sharply and goes away but I am worried that it may be nonunion. It usually happens when I move a certain way, but sometimes pops several times with pain before it "settles down". It's probably nothing, and the Dr will look at my X ray next week, but wondering if anyone has had similar issues and what was it? Would love to see that this happens to everyone so I stop worrying (sort of like the elbow pain from immobilization… ouch! but I found out later from another person with a shoulder injury.. very normal). My doctor is very competent but gives minimum information and only answers the exact question you ask.. no elaboration..

  66. sukhpreet says

    sir,

    i had an accident on 16 feb, 2012,in that my right humerus get broken in 2 pice.

    doc told me that make the plaster for 12 weeks anafter that ur bone will healing. its healed but mis aligment of humerus take place abut 20 to 30 deg. so tell me its any danger sing or its ok..

  67. Dr Arun Pal Singh says

    @sukhpreet,

    It is fine if humerus unites with that much angulation.

    There is no danger per se.

  68. sukhpreet says

    Hello sir,

    Thanx, for giving ans of my query.

    Sir now after 4 months doc told me to wear brace. Sir can u tell me that what is need of brace and how they can help me.is this PVC brace straight my angle humerus shaft.

  69. Thomas says

    Hello sir,

    I had broken my humerus (near shoulder) in June of 2011. The doctor had me spend 8 weeks in a sling (I was 14 at the time). After about 11 weeks total he said I was completely healed and I had no pain. But, if I swing my arm in a full circle it makes a cracking noise and o am not sure what causes this.

  70. cindy says

    Im 33 year old female. I fracture my left humerus mid-shaft on july14. I was on splint and sling till august 14 when it was replaced with a brace. My arm was very swollen but swellen has gone and arm is little to no pain. My question is ,what are signs that bone is healing?

  71. Dr Arun Pal Singh says

    @Thomas,

    If the bone is united [determined radiologically], the crackling sound should not cause much concern.

  72. Alexander says

    hello doctor ,

    i broked my proximal humerus in april 1 , used a sling . Today i had xrays taken and i see a displacement of 7mm. Im wooried about it. Whats your opinion?
    I can send my xray.

    thanks

  73. Dr Arun Pal Singh says

    You need to tell more about your condition and if possible please let me have a look at the xray.