Humeral Shaft Fracture Repair

What is Humeral Shaft Fracture Repair?

The humerus is the bone that forms the upper arm. It articulates with the glenoid cavity of the scapula (shoulder blade) to form the shoulder joint and with the lower arm bones – the ulna and radius – to form the elbow joint. The middle of the humerus is called the humeral shaft and a fracture of this section of the bone is called a humeral shaft fracture. It can be classified into Type A, B, or C fractures.  Type A fractures are simple fractures where the bone is not shattered. Type B fractures are fractures when the broken bone forms a wedge, and type C fractures are where the bone is shattered into many pieces.

Humeral shaft fracture repair is a procedure performed to heal a broken (fractured) humeral shaft using conservative or surgical treatment methods. The procedure mainly focuses on the reduction of the fracture and holding the fractured ends of the bone in the proper position during the healing process to ensure normal function after the fracture heals.

Indications for Humeral Shaft Fracture Repair

You may require a humeral shaft fracture repair on the following conditions:

• A high-impact collision, such as a motor vehicle accident
• Falling onto an outstretched arm
• A direct blow or injury to the middle of the humerus
• Weakening of the humeral bone due to pathological fractures. Pathological fractures are conditions that weaken your bones. These conditions include osteoporosis, bone tumors or cysts, bone cancer, and bone infection. 
• Considerable pain and swelling
• Visible bone deformity
• Inability to move the shoulder
• A sensation of grinding on moving the shoulder

Preparation for Humeral Shaft Fracture Repair

Preparation for humeral shaft fracture repair may involve the following steps:

• A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
• You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery has been explained.

Procedure for Humeral Shaft Fracture Repair

Most mid-shaft humerus fractures are minimally displaced and can be treated with conservative approaches such as the use of a sling to immobilize your arm for about a week and afterward a fracture brace is fitted to your arm. The fracture brace holds the broken edges of the humerus in position to ensure proper healing.

The healing of humeral shaft fractures by conservative methods can take up to twelve weeks. Even after this period, the complete joint functionality and mobility can only be recovered over time with proper exercise and physical therapy. This long recovery period is the main reason why most people prefer surgical procedures for the treatment of these fractures.

However, in the case of displaced fractures, multiple fractures, open fractures where the bone protrudes through the skin, or injuries to major blood vessels or nerves; surgery is the first line of treatment.

Open Reduction and Internal Fixation (ORIF): Open reduction and internal fixation is the most commonly used surgery to repair a humeral shaft fracture. The surgery is performed under sterile conditions in the operating room under general anesthesia. 

• After sterilizing the affected area, your surgeon will make an incision around the upper arm muscles. 
• Your surgeon will locate the fracture by carefully sliding in between the muscles of the humerus. 
• Your surgeon will put the fragments of the humerus back into position (reduction). 
• Next, your surgeon will secure the fragments of the humerus to each other (fixation) by using metal plates, screws, wires, or pins.
• After securing the bone in place, your surgeon will close the incisions with sutures or staples and cover them with a sterile dressing.
• The arm is then usually placed in a sling for comfort and support.

Intramedullary Nailing (IMN): This is a less invasive surgical procedure that is relatively indicated for the treatment of a humeral shaft fracture occurring as a result of pathological fractures, severe osteoporotic bone, segmental fractures, or when the overlying skin limits open approach. The surgery is performed without disturbing the various nerves in the arm. During this procedure, a metal rod, known as an intramedullary nail, is placed into the central canal of the upper arm bone passing across the fracture site. Both ends of the intramedullary nail are screwed to the bone to keep the bones and nail in proper position while the fracture heals.

Postoperative Care and Recovery

In general, postoperative care and recovery after humeral shaft fracture repair involve the following steps:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
• You may experience pain, swelling, and discomfort around the operated area. Pain and anti-inflammatory medications are provided to address these.
• Antibiotics are also prescribed to address the risk of surgery-related infection.
• You may also apply ice packs to the treatment area to help reduce swelling and pain.
• Your arm will be secured with assistive devices such as a sling for the first few weeks to rest the arm and promote healing.
• You are encouraged to move around in bed and walk as frequently as possible to prevent the risk of blood clots.
• Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
• Refrain from strenuous activities and lifting heavy weights for at least a couple of months. A gradual increase in activities is recommended.
• An individualized physical therapy protocol is designed to help strengthen your upper arm muscles and optimize upper arm function.
• You will be able to resume your normal activities in a few months, but with certain activity restrictions.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Humeral shaft fracture repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:

• Infection
• Bleeding
• Blood clots
• Malunion or non-union
• Hardware failure
• Recurrent instability
• Nerve injury