Humeral Head Fracture

What Is a Humeral Head Fracture?

The humerus, or Os humeri, refers to the upper arm bone. It can be divided into four sections: Head, neck, shaft, and lower end. A break ("fracture") often occurs at the upper head near the shoulder, for example, when you fall on your shoulder. Thus, a humeral head fracture refers to a humerus bone broken at the upper end.

Causes and Symptoms

A humeral fracture occurs either from a direct fall on the shoulder or blunt force on the bone. Falls on the wrist or elbow can also fracture the humerus. In people up to age 60, sports injuries and traffic accidents, and work accidents are among the most common causes. For people over 60, falls at home are top of the list.

If the bone is already pre-damaged, fractures occur more quickly. Diseases that affect the strength of the bone are, for example, osteoporosis, high alcohol and tobacco consumption, and conditions of the cardiovascular system.

A humeral head fracture is very painful. The pain can be directly in the shoulder and the upper arm or even in the hand. Numbness is also possible. In addition, the shoulder cannot be moved or rotated as usual. A hematoma, or "bruise," often appears in the tissue above the injury as the day progresses.

How is a Humeral Head Fracture Diagnosed?

If a humeral head fracture is suspected, an X-ray is taken. The shoulder and the upper part of the humerus are X-rayed from two sides to obtain a full view of the joint. Alternatively, a computed tomography ("CT") scan may be performed. Definitive diagnosis by magnetic resonance imaging ("MRI") is relatively uncommon and should only be used in exceptional cases. If there is no apparent cause for the fracture, a blood test is carried out in parallel with the X-ray to look for evidence of a disease, for example, osteoporosis.

Humeral Head Fracture Treatment

The goal of treatment is to regain good function of the arm and shoulder. Whether or not a fracture requires surgery depends mainly on the degree of complication of the fracture and the existing bone quality, biological age, concomitant diseases, and the functional demands of the affected person. For example, a young professional soccer player has different needs on his shoulder joint than a 60-year-old office employee.

Conservative Therapy

Most humeral head fractures can be treated conservatively, i.e., without surgery. Usually, these are fractures that are either not dislocated or can be returned to their correct anatomical position.

Conservative therapy focuses on pain medication and physical therapy and applying a Gilchrist or Desault bandage for two to three weeks. After the bandage is removed, a checkup X-ray should be taken.

Humeral Head Fracture Surgery

The decision to operate should be made carefully and together with the patient. In general, surgery is recommended if the fracture is more significant than 1 cm (according to Neer) or larger than 0.5 cm (according to Lill) or if the angle between the fracture is more significant than 45°. If a fracture is more complicated or even causes nerve and vascular damage, surgery should be performed.

Aftercare and Chances of Recovery

The arm and shoulder should not be moved during the first week if possible. After that, physiotherapy and independent exercises at home can be started. If numbness or circulatory problems occur in the affected arm, the patient should see the doctor immediately. If necessary, painkillers can be taken. After two to three weeks, a new X-ray checkup is carried out.

The chances of recovery from a humeral head fracture are good but depend on numerous factors such as age, bone quality, concomitant diseases, and a patient's willingness to participate in therapy actively. In addition, chronic pain in the shoulder joint may develop as a remnant of the fracture, or there may be limited motion and decreased strength in the arm or shoulder.

Which Doctors and Clinics Are Specialized in Humeral Head Fracture?

You should see a trauma surgeon for humeral head fractures. Trauma surgeons deal primarily with physical injuries, especially after accidents, and are the best professionals to contact for a broken bone. Shoulder surgeons are also the right professionals to get in contact with if surgery is necessary.

We will help you find an expert for your condition. All doctors and clinics listed have been reviewed by us for their outstanding specialization in humeral head fracture and are awaiting your inquiry or treatment request.

Sources:

• Deutschen Gesellschaft für Unfallchirurgie e.V. (DGU)https://www.awmf.org/uploads/tx_szleitlinien/012-023l_S1_Oberarmkopffraktur_2017-10.pdf , de.wikipedia.org/wiki/Proximale_Humerusfraktur