The humerus is the one and only bone of the upper extremity. It extends from the shoulder to the elbow - the humeral upper extremity is articulated with the clavicle and the humeral lower extremity forms the elbow joint, along with the radius and the ulna. The aging of population has led to the “skyrocketing” of humerus fracture percentages in developed countries. They are considered common injuries in older individuals, especially in women over 65 years.
Depending on where the lesion is found, they are divided into: a) humeral head fractures, i.e. close to the shoulder, b) diaphyseal fractures, i.e, near the middle of the bone, and c) distal end fractures, i.e., near the elbow. The latter case usually constitutes a complex injury of the specific joint.
HIGH RISK GROUPS
By looking through the literature, but through clinical experience as well, there is a link between the injury mechanism and the type of fracture. For example, if someone is trying to arrest the fall by extending the arm, it is more likely for them to suffer a humeral head and/or diaphyseal fracture. Accordingly, a distal extremity fracture is more likely to occur in a car accident or a football player who falls after a tackle.
Also, these “fall-related fractures” are much easier to occur in patients with osteoporosis, bone cancer, bone cysts or tumors, and bone infections.
WHICH ARE THE SYMPTOMS?
Symptoms may vary, depending on the type of fracture; however, the most common ones are: pain, swelling and bruising, inability to move the shoulder (and if an extremity nerve lesion coexist), crepitus (a crackling sensation), and deformation. Bleeding is also observed in open fractures.
WHICH IS THE BEST TREATMENT
Humeral head fractures account for 5% of fractures in the human body, while the corresponding percentage for diaphyseal fractures is of 3%. The treatment of fractures in this specific bone is mainly conservative, as the probability of healing is very high.
Depending on the type of injury, the patient’s medical history, their age, and level of physical activity intensity, the suitable method of immobilization (hanging cast, U-slab - or sugar-tong splint -, specialized functional brace) for 2 to 6 weeks, is selected. However, in cases where conservative therapy fails, or there are unstable and displaced fractures, surgical treatment is selected, in order for osteosynthesis to occur - wires, percutaneous needles, plates, and screws are used, where appropriate.
In particular, however, the humeral head fracture is an injury which is treated differently by orthopedists. It is considered particularly demanding, and requires for the surgeon to have an excellent knowledge of the anatomy of the area and experience in selecting the most appropriate surgical technique.