Humeral head fracture (humerus head fracture)

The Humeral head fracture or Humerus head fracture is a fracture (broken bone) that is particularly common in older people. It is noticeable through severe pain and limited mobility of the affected arm and is usually caused by falls on the outstretched arm, which were caught with the hand, so that the shaft of the humerus is driven up through the head. Alternatively, the fracture can result from falling directly on the shoulder, usually only parts of the head break off.

What is a humeral head fracture?

With a humeral head fracture, there is typically a painful restriction of movement in the shoulder area. In the area of ​​the head of the humerus and above there is a swelling that is painful when touched.
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The Humeral head fracture is by definition a fracture of the humerus head, i.e. above the neck. The neck of the humerus is not easily demarcated, which is why it is generally referred to as a humeral head fracture when the humerus above the shaft is broken.

It has to be differentiated from a humeral shaft fracture or a distal humerus fracture, i.e. a humerus fracture at the elbow joint. A so-called subcapital humerus fracture occurs when the shaft breaks at its transition to the humeral head and the shaft is only pushed slightly into the humeral head.

causes

The main cause of Humeral head fractures are falls in which patients try to support themselves with an outstretched arm or falls directly onto the shoulder. It mainly affects older people who already suffer from osteoporosis.

In severe osteoporosis, a strong blow on the shoulder is enough and the humeral head breaks. This blow can come either from the side or from above. The shoulder joint is the most unstable joint in the whole body, the ratio between the joint head and socket is 4: 1. The joint is only stabilized by the muscular rotator cuff (several muscles give off fibers that almost completely surround the joint).

However, the rotator cuff cannot protect against fractures, so both dislocations ("dislocated" joint) and fractures are common here. However, the fracture can also occur in young people after major trauma, for example in skiing accidents or falls from a great height on the shoulder.

Symptoms, Ailments & Signs

With a humeral head fracture, there is typically a painful restriction of movement in the shoulder area. In the area of ​​the head of the humerus and above there is a swelling that is painful when touched. This pressure pain is usually accompanied by sensory disorders or paralysis.

A bruise may appear in the armpit area, which can reach the inside of the arm and the side of the chest. Affected people often move their arm in a relieving position due to the pain and support it with the other arm. If the humeral head fracture is associated with a dislocation of the humerus head from the shoulder socket, it can be clearly felt under the skin.

A simple humeral head fracture cannot be seen externally. However, the symptoms can usually be traced back to a specific cause. Assuming early treatment, the symptoms will subside after four to six weeks. The movement restrictions can persist for up to two months.

Permanent restrictions may remain. Chronic pain can arise or mobility is permanently reduced due to a humerus head that has not grown together optimally. If the humerus head is broken into many fragments, the symptoms mentioned can be very intense. Bone fragments may come off and cause tissue damage.

Diagnosis & course

The diagnosis is relatively easy to make. The patient comes to the doctor with pain in the shoulder. The first thing to do after the physical examination is an X-ray examination, on which the fracture can usually already be seen.

Computed tomography is then used to determine more precisely how the individual fragments of the bone are positioned. The course of a humeral head fracture is usually good because the therapy, especially if a prosthesis is used, can restore full mobility of the arm.

Complications

In the further course of a humeral head fracture, complications can occur. It is not uncommon for various injuries or impairments to the nerves or vessels that are located in the shoulder area to appear as a direct consequence. As a result, the affected people suffer from symptoms of paralysis or circulatory disorders.

In some cases, with both conservative and surgical therapy, partial stiffening of the shoulder joint occurs. This complication can usually be treated by arthroscopic capsule splitting, which is combined with anesthesia mobilization and regular physiotherapeutic measures.

In some patients, the humeral head fracture does not heal properly. As a result, there is a risk of so-called pseudarthrosis, also known as the false joint. A pseudarthrosis is when the broken bone fragments do not grow back together correctly to form a joint.

Further conceivable complications are a renewed malposition of the fracture, the death of the humerus head, which affects older patients in particular, a labrum lesion, which is an injury to the joint lip, and a rotator cuff tear. The rotator cuff is a group of four muscles that play an important role in shoulder movements.

If there is a severe fracture of the humerus head, there is a risk of injury to the axillary artery or nerves. After an operation on the humeral head fracture, it is also possible that infections develop in the surgical area. This complication is particularly feared by doctors because it makes further treatment much more difficult.

When should you go to the doctor?

Elderly people who experience severe shoulder pain after an accident or fall should consult their family doctor. A humeral head fracture is usually easy to treat, but needs to be clarified quickly by a doctor. That is why you should see a doctor quickly if you have unusual complaints in the shoulder area. This is especially true if the symptoms are rapidly increasing in intensity. If there are bruises, swellings or increased mobility restrictions, a doctor must be called in on the same day.

In the event of paralysis or circulatory disorders, it is best to go to the doctor's office or the nearest hospital immediately. People who suffer from severe osteoporosis are particularly at risk. The fracture occurs mainly in elderly people who have already suffered a fracture of the shoulder bones. Anyone who belongs to these risk groups should speak to their doctor or an orthopedic surgeon if they experience sudden pain. If signs of pseudoarthrosis appear after the treatment of a humeral head fracture, the responsible doctor must be informed.

Doctors & therapists in your area

Treatment & Theraie

The operation is then planned, whereby screws and wires are sometimes used and the entire humeral head is partly replaced (especially in patients with osteoporosis and arthrosis) and a so-called total endoprosthesis (TEP) is used.

There are many surgical options for treating fractures, the selection of which depends on which parts of the humerus head are broken and how, and how stable or unstable the patient's bone substance is. The operation is performed at Humeral head fractures always because this fracture, unlike broken ribs, does not grow back together properly on its own. In addition, the shoulder is simply too important a joint to allow proper healing to be left to chance.

After the operation, the patient is usually given a special bandage that fixes the arm in a certain position: angled at right angles in the elbow joint, about 30 degrees anteverted, i.e. rotated forward. If the arm is fixed close to the body, as was common in the past, there is a risk of pinching a nerve. This can lead to chronic complaints - which is why there are now special, prefabricated positioning pillows that are given to patients in a standardized manner during such operations.

It is important that the patient leaves the arm alone, but does not work with it too little; mostly physiotherapy is prescribed. The physiotherapists then ensure that the patient moves his arm at least every two days in such a way that healing is not endangered.

Outlook & forecast

The prognosis of the humeral head fracture depends on the severity of the damage and the age of the patient. With increasing age, there is usually no longer a full recovery. The bones become more unstable in the course of life and can no longer be adequately regenerated by the organism if damaged. In a large number of cases, elderly patients experience a permanent impairment of mobility and a decrease in general resilience.

In most cases, young patients have a significantly better prognosis. A complete healing is often documented for them. At the same time, in addition to age, the number of fragments is decisive for making a prognosis. The fewer fragments there are, the better the chance of recovery. Early diagnosis and prompt treatment will give the best results.

Surgical intervention is part of the treatment plan for all patients. This is generally associated with possible complications and risks. Patients with a weakened immune system show a delay in the healing process. If there are other underlying diseases of the skeletal system, the prognosis worsens by another. However, a fracture of the humeral head does not endanger the patient's life.In the worst case, mobility is restricted, which triggers a restructuring of everyday processes. In individual cases, this can lead to psychological complications.

prevention

One Humeral head fracture It's hard to get out of the way, because nobody willingly falls on their shoulders. However, particularly old people can prevent osteoporosis and the resulting increased fragility of bones by exercising a lot and ensuring an adequate calcium intake. Calcium is particularly abundant in milk and milk products.

Aftercare

Follow-up care depends on whether the therapy was carried out by means of an operation or, as in most cases, by immobilizing the fragments using orthotics. Postoperatively, follow-up examinations for wound control must be observed, during which the doctor develops an individual therapy plan to achieve normal mobility.

If the person concerned has been provided with an orthosis, he may and should use his hand and fingers, but not lift any objects whose weight exceeds that of a full cup or a telephone receiver. To prevent the elbow joint from stiffening, the orthosis must also be removed several times a day and the elbow must be moved carefully. After three to six weeks, careful arm movements can be started. If the patient is unsure about this, he can get support from a physiotherapist.

A check-up after about six weeks will decide whether the orthosis has to be worn or can be removed. In children with faster wound healing, this examination can be carried out after 4 weeks.

After 3 months, the muscle strength has recovered. However, sports activities should only be started four to six months after the start of therapy. Pain and swelling can occur at any time during the first year and is nothing to worry about.

You can do that yourself

After the medical treatment of the humeral head fracture, the patient initially immobilizes the affected arm and as far as possible avoids any strain on the injured shoulder. In this way, it prevents possible complications and promotes the healing process of the fracture and, in the case of surgical intervention, also the healing of the wound. All physical strain must be avoided during the initial healing phase. Do not exercise for the time being, as the risk of injury is too high and shoulder overexertion is likely. In the case of difficult but necessary movements, we recommend the support of another person.

In the further course of healing, physiotherapeutic exercises help restore the load-bearing capacity and mobility of the affected shoulder. The patient first practices physiotherapy with a physiotherapist and then performs it regularly at home in order to quickly rebuild the muscles.

Later, in consultation with the doctor, it is possible to apply pain-relieving ointments externally to the shoulder area, for example with a cooling or warming effect. If there is a scar, the patient will relieve unpleasant symptoms such as pain or pulling in the scar area with adequate scar care. Gradually, under medical supervision and guidance, the patient increases his physical activity again, which has a positive influence on the general quality of life.