eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Humerus: Follow-up

Author: Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Coauthor(s): Adarsh K Srivastava, MD, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Oct 28, 2009

Follow-up

Further Inpatient Care

  • Open fractures
    • These require extensive irrigation.
    • Administer prophylactic antibiotics, such as cephalexin or gentamicin.

Further Outpatient Care

  • Proximal humerus fracture
    • Displaced 3- or 4-part fractures frequently require surgical fixation.
    • Open reduction and internal fixation is common in young patients.
    • Humeral arthroplasty in older patients is common.
    • For nonsurgical fractures, continue sling for comfort and institute early range of motion (ROM) exercises.
    • Schedule initial follow-up visit within 1 week.
  • Humerus shaft fracture
    • Most humerus shaft fractures are treated nonoperatively with an expected union rate of 90-100%, though surgical fixation, by either intramedullary nailing or plating, is necessary if the fracture is segmental or the vasculature is compromised.
    • Use coaptation splint until immediate postfracture pain has subsided, usually within 3-7 days. Then, place the patient in a functional brace.
    • An orthopedic surgeon best addresses decisions regarding alignment, rotation, and progression to union

Inpatient & Outpatient Medications

  • As with all fractures, provide adequate outpatient analgesia especially during the first few days. Narcotic analgesia may be appropriate.

Complications

  • Proximal humeral fracture
    • The most common complication is adhesive capsulitis. This can be prevented by the early initiation of a rehabilitation program.
    • Two-part fractures of the articular surface and 4-part fractures have a high incidence of avascular necrosis of the humeral head.
    • Repeated forceful attempts at reduction of a fracture dislocation may be associated with subsequent heterotropic bone formation.
  • Humeral shaft
    • The most common complication in humeral shaft fractures is radial nerve injury. The nerve deficit is usually a benign neurapraxia that resolves spontaneously, although recovery may take several months. 
    • Radial nerve injuries associated with penetrating trauma or open fractures are likely to be permanent and usually warrant operative exploration.

Prognosis

  • Proximal humeral fractures
    • Complete union is expected at 6-8 weeks.
    • Older patients often exhibit a functional decrease in shoulder ROM.
  • Diaphyseal fractures
    • These fractures have a high rate of union.
    • Residual angulation is well tolerated because of compensation by shoulder and elbow ROM.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to assess and document radial nerve function in humerus shaft fracture
  • Failure to recognize a glenohumeral dislocation associated with a proximal humerus fracture. This may increase risk of avascular necrosis of humeral head.
 


More on Fracture, Humerus

Overview: Fracture, Humerus
Differential Diagnoses & Workup: Fracture, Humerus
Treatment & Medication: Fracture, Humerus
Follow-up: Fracture, Humerus
Multimedia: Fracture, Humerus
References
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References

  1. Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. Nov 2008;90(11):1407-13. [Medline].

  2. Cheung EV, Sperling JW. Management of proximal humeral nonunions and malunions. Orthop Clin North Am. Oct 2008;39(4):475-82, vii. [Medline].

  3. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. Sep 1970;52(6):1077-89. [Medline].

  4. Brukner P. Stress fractures of the upper limb. Sports Med. Dec 1998;26(6):415-24. [Medline].

  5. Ogawa K, Yoshida A. Throwing fracture of the humeral shaft. An analysis of 90 patients. Am J Sports Med. Mar-Apr 1998;26(2):242-6. [Medline].

  6. Pehlivan O, Kiral A, Akmaz I, Solakoglu C, Arpacioglu O, Kaplan H. Humeral shaft fractures secondary to throwing. Orthopedics. Nov 2003;26(11):1139-41. [Medline].

  7. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. Aug 2006;37(8):691-7. [Medline].

  8. Brown CC, McQueen MM, Tornetta III P. Orthopedic Surgery Essentials: Trauma. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:89-114.

  9. Baron AA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone. 1996;18:209S-13S.

  10. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. Dec 2005;87(12):1647-52. [Medline].

  11. Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and imaging of proximal humerus fractures. Orthop Clin North Am. Oct 2008;39(4):393-403, v. [Medline].

  12. Anglen JO, Archdeacon MT, Cannada LK, Herscovici D Jr. Avoiding complications in the treatment of humeral fractures. J Bone Joint Surg Am. Jul 2008;90(7):1580-9. [Medline].

  13. Byrd RG, Byrd RP Jr, Roy TM. Axillary artery injuries after proximal fracture of the humerus. Am J Emerg Med. Mar 1998;16(2):154-6. [Medline].

  14. Keller A. The management of gunshot fractures of the humerus. Injury. Mar 1995;26(2):93-6. [Medline].

  15. Mckee MD. Fractures of the shaft of the humerus. In: Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. Vol 1. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:1117-1159.

  16. McKee MD, Jupiter JB. A contemporary approach to the management of complex fractures of the distal humerus and their sequelae. Hand Clin. Aug 1994;10(3):479-94. [Medline].

  17. Minkowitz B, Busch MT. Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am. Oct 1994;25(4):581-94. [Medline].

  18. Niall DM, O'Mahony J, McElwain JP. Plating of humeral shaft fractures--has the pendulum swung back?. Injury. Jun 2004;35(6):580-6. [Medline].

  19. Rosen P. Emergency Medicine. 6th ed. Mosby-Year Book, Incorporated; 2006:647-69.

  20. Szyszkowitz R, Seggl W, Schleifer P, Cundy PJ. Proximal humeral fractures. Management techniques and expected results. Clin Orthop Relat Res. Jul 1993;13-25. [Medline].

  21. Tintinalli J, Ruiz E, Krome R. Emergency Medicine. 4th ed. McGraw Hill Text; 1996:1242-1244.

  22. Warner JP, Costouros JG, Gerber C. Fractures of the proximal humerus. In: Bucholz RW, Heckman JD, Brown CC, eds. Rockwood and Green's Fractures in Adults. Vol 1. 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2006:1161-1205.

  23. Wilkins KE. Supracondylar fractures: what's new?. J Pediatr Orthop B. Apr 1997;6(2):110-6. [Medline].

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Further Reading

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Keywords

broken humerus, humerus fracture, fractured humerus, broken arm, broken shoulder, shoulder fracture, arm fracture, forearm fracture

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Contributor Information and Disclosures

Author

Andrew A Aronson, MD, Assistant Professor of Emergency Medicine, Drexel University School of Medicine; Consulting Staff, Department of Emergency Medicine, Allegheny General Hospital
Andrew A Aronson, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Adarsh K Srivastava, MD, Staff Physician, Department of Emergency Medicine/Internal Medicine, Allegheny General Hospital
Adarsh K Srivastava, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michelle Ervin, MD, Chair, Department of Emergency Medicine, Howard University Hospital
Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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