Broken upper arm - you need to know that now!

General

Of the upper arm (medical: Humerus) represents one of the largest bones in the human skeleton represent. a fracture this bone can get through different causes be evoked. Usually, depending on the cause of the injury typical fracture shapes. At the most common is the part of the humerus affected which the Transition between the humeral head and the humeral shaft represents. At this point, which is close below the shoulder, the bone is weakest and therefore predestined for the development of a fracture. In general, an upper arm fracture usually occurs when external force on the bones is perpetrated or the Bone overused from twisting becomes.

Depending on Expression of the break come various therapy options to treat the injury. Especially crucial for therapy as well as the course of the humerus fracture is the distinction between one open and closed fracture. A open break exists when the Layer of skin damaged by at least one of the bone fragments has been. In addition to the type of fracture, other individual factors of the person concerned are also decisive for the prognosis of the healing of the bone. For example, the Age or previous illnesses as a osteoporosis have an adverse effect on the healing process. In children, on the other hand, bone fractures usually heal better than adults.

Generally speaking, one arm fracture occurs relatively long healing process to go out as it is a heavily loaded bones and bone healing is slow. The mean length of hospital stay after an upper arm fracture, depending on the location and type of fracture 5-14 days. Until one complete healing typically pass away 6 weeks to 3 months.

Symptoms

A broken upper arm goes with it typical symptoms a broken bone. Strong pain occur at the affected area with every bone fracture and are also typical when the upper arm has broken. The pain can vary depending on the location and type of fracture and the soft tissue structures involved, but is usually referred to as severe, bright, stabbing pain described. To the upper arm swells for only a few minutes after an upper arm fracture and a bruise.

Another symptom that occurs very often with a broken arm is a Restriction of movement in the affected arm. This restriction of movement is usually caused by the displaced bone fragments evoked. One is also noticeable typical relieving posture which is automatically accepted in the event of a fracture of the humerus. For example, those affected usually lift the wrist of the injured arm a little with their healthy hand. This gentle posture reduces the stress on the humerus and is therefore less painful than simply hanging the affected arm down.

If the Bone fragments shifted very strongly against each other are can be Misalignment of the upper arm indicate the fracture. At open fractures is the Skin of the upper arm of one or more bones pierce been. An enormous misalignment of the upper arm and a bleeding wound are typical symptoms of an open fracture.

If the rupture has caused damage to nerves and vessels, functional limitations of the arm or hand as well as sensory disorders can occur.

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Pain in a broken arm

Regardless of the exact location, an upper arm fracture is usually very painful. Responsible for this is first of all the bursting of the bone itself, along with it Periosteum is supplied by pain fibers. These pass the information on to the brain, which perceives the signal as pain. Furthermore it will Muscle and fat tissue damaged around the bone, which intensifies the pain. If a nerve is pinched directly, on the one hand it can Loss of sentience (Sensitivity) come on the skin. On the other hand, the irritation of the nerves can lead to burning, shooting pain. In both cases, an operation should definitely be carried out to avoid permanent consequences. Before taking any further measures, the doctor will first give the patient appropriate pain therapy. Are good for this Ibuprofen, Paracetamol or Novalgin.

causes

The causesthat can lead to an upper arm fracture are numerous. In the foreground are injuries caused by a strong force go along on the humerus. Also Twists of the upper arm can break the bone. Typically these occur Injuries while exercising or Traffic accidents on. Especially when high speeds the effects of force on the bones are very high. In medicine, a high speed injury followed by violence is called so-called "High-speed trauma" described.

In addition to these obvious reasons that cause an upper arm fracture, individual diseases can also contribute to an increased likelihood of an upper arm bone. Especially if one osteoporosis exists is the Limited bone stability and fractures occur even with relatively little stress on the bones. For this reason, if there is a fracture in the upper arm, which after a small amount of force occur a accurate diagnostics be made to where appropriate discover systemic diseases and therapy to be able to.

In rare cases you can also Metastases of certain tumors or tumors of the bone be responsible for ensuring that the humerus breaks without major injuries. The Tumor tissue in this case spreads in the bone and limits the stability. A typical fracture of the upper arm caused by a tumor is a Break in the middle of the bone, which is also called Bone shaft fracture referred to as.

therapy

The treatment of an upper arm fracture basically depends on the type of fracture. In general, an targeted pain therapy so that the typically pronounced pain associated with an upper arm fracture is eliminated.

Depending on whether the Bone fragments shifted against each other are or not must be a surgical therapy respectively. If there is only one fracture of the bone, the two Fragments, however, still lie on top of one another and can not be moved conservative care suffice the injury. One is particularly important here Immobilization of the arm, which are usually indicated by the Applying a plaster cast or by means of a so-called Gilchrist noose is achieved. Depending on the age of the person concerned and the type of injury, these must 4-6 weeks worn until the bone has healed and the bandage or sling can be removed.

At displaced bone fragments and for fractions with a significant soft tissue injury go along is usually a surgical intervention necessary in order to be able to adequately treat the injury. The correct anatomical position the bone fragments is essential for optimal healing and the later freedom from symptoms in the upper arm. There are different ways to treat the fracture surgically. The bone fragments can with Plates and screws as well as with Nails and wires are supplied. Which method is used individually depends on the respective situation and the injury. Even after surgical treatment of the upper arm fracture is a Immobilization of the upper arm by means of a Gilchrist noose important for optimal healing of the bone.

Open fractures assign a significant risk of infection on why a systemic therapy with antibiotics is enormously important. If the soft tissue is severely injured, it may be necessary to wait until the soft tissue has healed before supplying the bone.

When the humeral head is affected and the Articular surface restricted is, can Implantation of an artificial shoulder joint to be necessary. If there is a fracture that passes through the articular surface, there is a high probability of the Development of osteoarthritiswhich can be prevented by inserting the artificial joint. This is also necessary if the blood supply to the joint is restricted by the fracture.

The implanted plates, screws, nails or wires are removed after 12 months at the earliest, while the prostheses remain in the body for the rest of their life.

Operation of an upper arm fracture

When is an operation necessary?

In principle, there is the option of conservative and surgical treatment in the case of a fracture of the upper arm. For one conservative therapy (Immobilization in a plaster cast) special requirements must be met: On the one hand, the two ends of the fracture must not be shifted against each other. The two broken ends must not be more than an inch apart. In the majority of cases, this is one Humerus head fracture (Humeral head fracture) applicable.

If the above requirements do not apply, a humeral head fracture must be treated surgically. In addition to displaced, slipped and widely spaced fractures, everyone must Comminuted fractures be treated surgically. Furthermore will all open fractions (in which the bone is visible to the outside) and fractures with injuries to soft tissues, nerves or blood vessels are surgically treated. Also all breaks that joint (in the case of the upper arm, i.e. shoulder or elbow joint) must be operated on. Such fractures would not grow together properly under a simple plaster cast without an operation and thus permanently lead to pain and functional restrictions.

It is different with a break in the Middle of the upper arm (Humeral shaft fracture). These fractures are mostly treated surgically. The exception are uncomplicated fractures of the upper arm shaft in children, which can often be treated conservatively. In general, the decision depends on the age of the patient, bone density, other pre-existing conditions and other factors and is ultimately an individual decision in order to provide the patient with the best possible therapy.

What options are there for surgery (plate / nail)?

A fracture of the humeral head can result various osteosynthesis techniques, techniques to put the bones together, are operated on. On the one hand, there is the use of Cheek wires in question, which can be used in a minimally invasive manner, i.e. without large incisions. Also so-called Intramedullary nails can be used in a minimally invasive manner. They come to lie in the interior of the bone (medullary canal) and thus fix the fragments of the upper arm from the inside. Another option of supply are Metal plateswhich are mainly used for fractures near the joints and in children. If the humerus head has been damaged too much, it must be replaced by a Metal prosthesis be replaced. Fractures in the area of ​​the humerus shaft can either be treated with the use of a plate or an intramedullary nail.

If there are multiple injuries, e.g.in the context of a traffic accident, or if there is pronounced soft tissue damage, then a External fixator be created. This is a wire frame that is anchored in the bone by pins and fixes the fracture ends from the outside. This frame can also be used with children.

Duration

Duration of the entire treatment

The entire treatment of an upper arm fracture can extend to full resilience over several weeks and months extend. In younger people with good bone structure and uncomplicated fractures, bone healing takes place much faster. How long a cast is needed depends on the person Speed ​​of bone healing from.

The doctor tracks the healing process at regular intervals X-rays of the arm created. So he can decide when the cast can be removed. Usually this is the case after about four to ten weeks.

After a surgery bone healing occurs through the fixation of the fracture ends Nails or plates generally faster. After the immobilization one closes functional therapy (e.g. physiotherapy exercises) in order to restore the strength and freedom of movement of the arm.

Duration of healing

A broken upper arm usually takes at least several weeks to heal in the sense of complete resilience and freedom from pain. Fixing the broken arm during surgery accelerates bone healing. However, often is one conservative therapy sufficient. To do this, the arm must work in one for about four to ten weeks plaster cast be immobilized. This is followed by functional training in the sense of physiotherapy. Here the patient should regain his strength and freedom of movement in the arm.

Until this goal is achieved and the person concerned again Sports Drifting can take several weeks. This essentially depends on the Age and the quality the bone structure of the patient. In any case, it is advisable to contact the Recommendations of the attending physician to prevent relapses and permanent pain and limitation.

Duration of healing in the child

Because of a better one Regenerative ability heal Broken bones in children here more quickly than in the adult. Therefore, uncomplicated fractures of the arm in the child can also conservative are supplied. For this, the arm must be put in a cast and worn in a loop (so-called Gilchrist bandage). The cast is worn for around four weeks, depending on the age of the child.

In between, the doctor does more X-raysto assess the healing process and determine when the cast can be removed. During an operation, the two ends of the fracture are brought close together by a nail or plate so that the fracture can heal directly. This then happens faster than with a purely conservative care.

There is also one in children functional therapy (e.g. physiotherapy) necessary after immobilization in order to fully restore freedom of movement. Several weeks and months can pass before the child is fully resilient, depending on the age of the child, the location and complexity of the fracture.

Duration of the operation

How long the operation of an upper arm fracture takes depends primarily on the patient localization and the complexity of the break. In general, it can be said that the operation of a humerus fracture can take anywhere from thirty minutes to several hours.

If there is a simple fracture, it can be repositioned relatively quickly and fixed with a nail or plate. In the case of more complicated fractions, such as a joint include, significantly more time must be planned.

Is there a Comminuted fracture of the humerus head, it must be replaced by an implant, which is also associated with a longer operation time. To step Complications on, which can be the case with poor bone structure in older people, for example, the operation can also be significantly delayed.

Duration of the plaster

How long a cast has to be worn in the event of a broken upper arm depends on many factors. First of all, the localization of the fracture is crucial: it makes a difference whether the fracture is on the humeral head or shaft. In addition, of course, it is crucial whether the cast is the sole therapy or whether the cast was put on after an operation. During an operation, the broken ends are fixed to one another using nails, plates or wires. This leads to a direct bone healingwhich occurs much faster than bone healing with conservative therapy. Furthermore, the wearing time depends on the Age of the patient, the older the patient, the slower bone healing tends to be. In children, a broken bone usually heals particularly quickly. In adults, the cast must be worn for about four to ten weeks. The doctor checks the healing process with x-rays and can decide how long the cast has to be worn.

diagnosis

The diagnosis of an upper arm fracture must be individually adapted to the situation. At serious accidents for example, the fracture on the upper arm plays only a minor role and it should initially diagnosed and treated life-threatening injuries become. Upper arm fractures, which with a significant Displacement of the bone fragments usually represent a Eye diagnosis because the misalignment of the upper arm inevitably indicates a broken upper arm. The same applies to open fractures in which individual bone fragments protrude from the skin.

At less obvious upper arm fractures stands the anamnese in the foreground at the beginning of the diagnosis. Here are especially the perceived symptoms as well as the the accident important for diagnosis. Based on the circumstances of the accident, the level and direction of the force can be estimated and provide an indication of the stress on the bones and the surrounding soft tissue. The anamnesis is typically followed by the physical examination of the person concerned, with the symptoms of the injured upper arm being the main focus of the examination.

Around safety to get information about the presence of an upper arm fracture and to be able to assess the type of fracture imaging methods used. It depends on the type of injury, the availability of the equipment and individual factors of the person concerned X-ray machines, Computed tomograph, such as Magnetic resonance tomograph for use. Bleeding under the skin can also do well with a Ultrasound machine being represented.

forecast

The individual prognosis after an upper arm fracture depends crucially on this Severity of the injury, the nature of the break as well as from individual factors of the person concerned. Bones are tissues that heal very slowly. For this reason, the forecast is usually as easy to assess, the However, the healing time is relatively long. The aim of any therapy after an upper arm fracture is this unrestricted, painless movement of the upper arm in the elbow and shoulder joint. Especially when it is a simple fracture without displacement of the fragments, the prognosis is to be assessed as very good even with conservative therapy. At a operational care come the injury Surgery risk factors which can worsen the prognosis overall. Which includes Injuries to the structures of the upper arm during the operation as well as that Risk of required anesthesia.

Open upper arm fractures also have one worse prognosis. Especially those Risk of infection is significantly higher with an open fracture than with a closed humerus fracture. When the individual Bone fragments strongly displaced are also the Risk of injury to the surrounding soft tissues how Vessels or annoy. Damage to these structures can significantly limit the success of the treatment and thus worsen the prognosis of the fracture.

prophylaxis

Upper arm fractures are usually caused by considerable forces which usually occur in accidents or during sports. So can a general prophylaxis are not recommended before the most common upper arm fractures develop. At most one careful handling of sports, which are known for broken arms, is recommended here.

Diseases leading to a decreased bone stability should lead if possible treated to prevent the occurrence of an upper arm fracture. Especially when the Possibility of bone metastases or one osteoporosis exists is a Diagnosis and therapy of the disease expedient for a successful prophylaxis before the occurrence of a broken arm.