Humerus

About Humerus Fractures

The most common fractures of the shoulder that I see in my practice are fractures of the proximal humerus and fractures of the clavicle. Broken upper arms—humerus fractures—usually occur as a result of a fall.

A shoulder practitioner will make the diagnosis of fracture of the humerus or clavicle after obtaining a history, performing a careful examination, and reviewing imaging studies. Plain x-rays are usually sufficient to establish the diagnosis of a humerus fracture or the clavicle.

Treatment

Most proximal humerus fractures can be treated with immobilization. Immobilization is generally accomplished by the use of a sling and a component of the sling that wraps around the upper body called a swathe. A sling and swathe keep the arm and forearm at the side and is usually sufficient protection for the fracture.

A very small percentage of proximal humerus fractures will require surgery. Surgery is sometimes undertaken in an attempt to put the pieces back in a more proper position and maintain that position with plates, screws, wires, and the like. Sometimes surgery for proximal humerus fractures involves removing the ball of the shoulder and performing a shoulder hemiarthroplasty. A shoulder hemiarthroplasty is a procedure in which the ball the shoulders replaced with a metal ball and the tendons and muscles are reattached so that the new shoulder will work in the best way possible.

A lot of patients are surprised to learn that they do not need to wear a cast to treat a proximal humerus fracture. It’s also fine for the shoulder to have some gentle motion. The bone does not have to be held absolutely still for healing to take place.

I find that most patients will suffer some permanent impairment as a result of a proximal humerus fracture. Most find that their shoulder is stiffer than it was before. Some will develop arthritis years after the fracture as a consequence of the fracture. Most patients are able to return to doing almost everything that they used to do before the fracture occurred.

Treatment FAQs

What have I broken?

The bone that goes from the shoulder to the elbow is broken. It has broken in the vicinity of the ball of the shoulder.

Do I need surgery?

Most of the time, no. I will discuss that with you on your first visit. At this time your fracture is in a position that surgery is not the best treatment for you. During the healing phase, I will take more X-rays to monitor the healing process. In some cases the bones will move into a position that requires surgery later.

How do these usually turn out?

Most fractures heal well and allow patients to return to most of their normal activities. Your shoulder will lose some flexibility. In some cases, it will not be as strong as it was before the fracture. A few patients will develop arthritis of the shoulder as a result of their break.

Risks

What are some of the things that could go wrong?

In addition to the comments above, one may have nerve loss as a result of the break. This is rare.

How often does an infection occur?

Infection is probably less than 1 in 1,000 if surgery is not done.

Will my shoulder get stiff?

Some stiffness is a certainty with this type of fracture.

Bruising and Swelling?

It is very common to develop a tremendous amount of bruising from the fracture. The bruising will extend to the forearm, hand, and breast area. This is caused by bleeding from the fractured bone. Your body will heal the bruising after a month or so. Usually no permanent discoloration results, but sometimes darkening of the skin will be permanent.

Will I have limitations on what I can try to do after it is healed?

No. It is safe to pursue all activities without restriction once completely healed.

Risks

Tell me about those first few days after my break.

You will sleep best in an upright position, such as in a recliner. You will sleep poorly due to pain. An ice bag or other cold source on your shoulder will lessen your pain. Drugs for pain will help. You may feel a sense that the bones are moving. This is normal and not harmful.

What about the overall recovery from the fracture? How long does it take to completely recover?

Six months to one year.

Will I be hurting that long?

No. Generally by 3 months, patients are dramatically improved, but they continue to gain strength in the broken arm until 6 to ­12 months after fracture.

How long will I need prescription pain medication?

This varies widely. Most commonly, I see patients requiring narcotic analgesics until around two weeks following the fracture. One of the last discomforts to go away is nighttime pain, and many patients will still use a pain pill to help them sleep as long as 8 weeks after the fracture.

When can I get it wet?

As soon as you would like.

Will I have to wear a sling?

Yes. A sling is worn until 6 weeks have passed from time of fracture. It can be removed in certain circumstances. If you are resting comfortably in a chair at home, it is fine for the sling to be off. Whenever there is a risk that you might trip or fall, the sling should be on.

Clavicle

About Clavicle Fractures

Fractures of the clavicle are a common injury that I treat. “Broken collarbones” seem to be more commonly associated with higher energy injuries. When patients crash their bicycle or their motorcycle, they will sometimes break their clavicle.

A shoulder practitioner will make the diagnosis of fracture of the humerus or clavicle after obtaining a history, performing a careful examination, and reviewing imaging studies. Plain X-RAYS are usually sufficient to establish the diagnosis of a fracture of the clavicle.

Treatment

Clavicle fractures can be subdivided into several different types. Those that are minimally displaced or minimally angulated are usually treated without surgery. Those that have substantial displacement, shortening, or angulation may benefit from surgery.

I have a strong preference for a clavicle strap as the preferred method of treatment for clavicle fractures that are treated without surgery. It is okay to use a regular sling also. Both methods generally result in satisfactory healing.

I prefer a clavicle strap because I have found that most patients are more comfortable in a clavicle strap than they are when only using a sling. Many of the providers that render initial care in our area are unfamiliar with use of the clavicle strap. I have them in my office and am able to transition the patient from a regular sling into a clavicle strap with minimal discomfort.

No matter which method of treatment is used, broken collarbones hurt a lot. It is important to prepare for several weeks of discomfort.

Some clavicle fractures will do best if surgery is performed. Surgery generally involves the use of a plate and screws in an attempt to improve the alignment of the bone and hold the bone in that improved position.

When healing is complete most patients are able to return to full activity after sustaining an isolated clavicle fracture. Permanent deformity of the bone is common after the bone heals completely.

Treatment FAQs

What have I broken?

The bone that joins your breastbone to your shoulder blade, often called the “collarbone”.

Do I need surgery?

Most of the time, no. I will discuss that with you on your first visit. At this time your fracture is in a position that surgery is not the best treatment for you. During the healing phase, I will take more X-rays to monitor the healing process. In some cases the bones will move into a position that requires surgery later.

How do these usually turn out?

Most clavicle fractures heal well and allow a return to full activity. Deformity at the fracture is often permanent.

Risks

What are some of the things that could go wrong?

Occasionally a clavicle fracture will not completely heal. This is called a non-union.

How often does an infection occur?

Infection is probably less than 1 in 1,000 if surgery is not done.

Will my shoulder get stiff?

Usually not.

Bruising and Swelling?

It is very common to develop a tremendous amount of bruising from the fracture. The bruising will extend to the forearm, hand, and breast area. This is caused by bleeding from the fractured bone. Your body will heal the bruising after a month or so. Usually no permanent discoloration results, but sometimes darkening of the skin will be permanent.

Will I have limitations on what I can try to do after it is healed?

No. It is safe to pursue all activities without restriction once completely healed.

Risks

Tell me about those first few days after my break.

You will sleep best in an upright position, such as in a recliner. You will sleep poorly due to pain. An ice bag or other cold source on your shoulder will lessen your pain. Drugs for pain will help. You may feel a sense that the bones are moving. This is normal and not harmful.

What about the overall recovery from the fracture? How long does it take to completely recover?

About six months.

Will I be hurting that long?

No. Generally patients are healed by four months.

How long will I need prescription pain medication?

This varies widely. Most commonly, I see patients requiring narcotic analgesics until around two weeks following the fracture. One of the last discomforts to go away is nighttime pain, and many patients will still use a pain pill to help them sleep as long as 8 weeks after the fracture.

When can I get it wet?

As soon as you would like.

Will I have to wear a sling?

A clavicle strap or sling is usually needed for about six weeks.