Humerus Fracture Follow-up

Updated: Sep 24, 2015
  • Author: Adarsh K Srivastava, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Follow-up

Further Outpatient Care

See the list below:

  • 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
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Further Inpatient Care

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

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Inpatient & Outpatient Medications

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

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Complications

See the list below:

  • 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.
    • Claessen et al conducted a study to determine the factors associated with radial nerve palsy in patients with diaphyseal humerus fracture.  Open fractures, location of fracture, and high-energy trauma were significantly associated with radial nerve palsy (84 of 325 patients [26%]).  According to the study, iatrogenic transient dysfunction of the radial nerve occurs in approximately 1 in 5 patients who are treated with lateral exposure of the humerus, in 1 in 9 patients treated with posterior exposure, and in 1 in 25 patients treated with an anterolateral exposure. [18]
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Prognosis

See the list below:

  • 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.
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Patient Education

For patient education resources, see the Breaks, Fractures, and Dislocations Center, as well as Broken Arm, Shoulder Dislocation, and Broken Elbow.

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