Broken Humerus Not Healing (Page 9)

Merry Christmas, and Happy Holidays to everyone.

Everyday I see improvement. I've had 2 physio appointments and my next one is in January. I have lots of exercises to do at home. The main concern now is that I have a frozen shoulder, so all my exercises center around that. I'm still not able to lift anything, but I can use my right hand while typing. I find I automatically use my left arm/hand for most everything. I can't hold a pen steady yet, so I still write left-handed. I tried to start my car today, but found I can't turn the key. I also tried to pull the shifter down, and found I didn't have enough strength. So no driving just yet. I'll try again next week.

Sure is quiet around here. Happy New year everyone.

12 weeks post surgery I am now in physio twice a week. I have 108 range of movement in my right are when lifting it straight up in front of me. Apparently I need to get to 120. Still not cleared for driving till I see the surgeon again on Feb 14th.

Physio therapist thinks I'm ok to drive!!! But I need to wait for the surgeon to agree. Luckily my van is automatic and not standard shifting. I still don't have full range of motion in my shoulder. This could be due to the car accident I had before I broke my arm.

I just got done reading all the post (all 9 pages). I am a newbie here and just 2 weeks into what looks like the beginning of an adventure!Looks like I am in for a long haul. No surgery yet and in a "hanging" cast for the moment. I am a 64yr female. I appreciate all the sharing. It helps to hear from others in the same boat.

I just got done reading all the post (all 9 pages). I am a newbie here and just 2 weeks into what looks like the beginning of an adventure!Looks like I am in for a long haul. No surgery yet and in a "hanging" cast for the moment. I am a 64yr female. I appreciate all the sharing. It helps to hear from others in the same boat.

youngnbeautiful,

Welcome to eHealth.

While you are in the hanging cast, be sure to move your fingers as much as you can. They tend to get stiff very quickly, and it is very difficult to get the motion back later.

The hanging cast is bit different from the co-apt splint (also called clam shell or elephant ear splint). Usually, a hanging cast is used as a weight and the arm as a traction unit, so that the cast pulls the bone into a proper reduction. So, it takes a little finagling to get the position for the sling loop, so that just the right vector forces are applied to the broken bone.

And it is usually a full long arm cast, so you can't exercise the wrist or elbow. This is usually switched to a fracture brace (co-apt, clam shell, elephant ear) once the fracture ends get "sticky" with osteoid and callus formation.

Once you go to the fracture brace, again, be sure to work on range of motion of the fingers, wrist, and elbow. These joints get stiff real fast. You may also be allowed to do some pendulum exercises once you go to the brace. If so, be sure to work on the shoulder exercises also. You do not want a frozen shoulder after the humerus fracture has healed.


So, follow your surgeon's instruction concerning activity, sleeping positions, etc. It usually takes about 6-10 weeks for a humerus fracture to unite. Hopefully, you will be right on track.


Move those fingers!! Good luck.

Hello Gaelic: I never had a full arm cast at all. I had plaster strips from my shoulder down and around my elbow and back up to my arm pit from June - Nov. I was in a full sling that was tied around my waist and it also had a pillow cushion to hold my shoulder at a slight angle. Surgery was in Nov and I now have frozen shoulder.

Sandy,

That is what is known as an "elephant ear splint" to orthopedic residents. It is usually used for a transverse midshaft fracture that does not need relignment, just some stability for comfort.

Usually, but not always, a hanging arm cast is a type of "wearable traction device". It is used in fracture patterns that need certain vector forces applied to it to keep it in an adequate alignment. So, the weight of the long arm plaster cast pulls down on the distal fracture fragment, then depending upon where the loop is placed on the forearm section, the pull of the sling will provide side to side, and rotational vector forces. It is a real art to get that sling loop in just the right position.

Too far out towards the wrist, or too close to the elbow, and the upper part of the cast acts like a fulcrum and displaces the fracture. If the loop is placed too far around the front of the cast, or back towards the abdomen too far, again, the wrong forces are applied.

So, treating a humerus fracture with a hanging arm cast is a real trick. You have to get everything just right. But, when it works, it is a great device. It is mostly used for long spiral oblique fractures, that have a tendency to angulate severely.


So, most humerus fractures are either transverse or short obliques, that can be treated in a fracture brace of some type, once the fracture gets sticky. The elephant ear is usually, not always, a temporary splint, till a co-apt, or clam shell, brace can be made. In some cases, the elephant ear is used exclusively.


Hope your appointment goes well. Have fun driving.

Any advice would be more than welcome, I broke my humerous in several places 3 weeks ago.I had surgery and a plate put in, I was sent home with a few leaflets on how to look after my cast which I didn't have. My first out patient appointment was yesterday, I was sent for x-ray and returned to the fracture clinic, when iIgot to see the doctor my x-ray wasn't coming through on his computer so he sent me down to o.t. where I was given another splint for my hand and told to keep it on at all times, I was also given what looks like the top of a roll on deodorant to rub up and down my arm as it is quite swollen with fluid still, They didn't seem to know whether I should still be wearing a sling or not and thought it was too early for physio. They told me to go back to the doctor to see what he thought, When I got back there where at least 15 people in front of me, I had been there for two and a half hours and my daughter was due back from school so I left.Any advice would be much appreciated, Mandy

inpain45,

Welcome to eHealth. I almost missed your message, it was buried in the plethora of postings.

Let me make sure I have things straight.

You sustained a comminuted humerus fracture, which as treated with an ORIF (open reduction and internal fixation) using a plate (and screws). This was around 3 weeks ago.

You also have some injury to your hand or wrist, which is being treated with splinting.


Hope that is correct.

We cannot give you specific medical information, because we do not have access to your x-rays and do not know exactly what injuries you have. So, the best place to get that is from your surgeon. That said...


As to the swelling and edema you have, that is best treated with finger motion and elevation. With the humerus being fixed, you should be able to elevate the hand some. The finger motion and elevation will help to push the swelling back into the body.

The little roller tool you have is to help push the edema back up the arm. You should start distally (away from the body) and push it up the forearm/arm proximally (towards the body). You can also you massage. Massaging and pushing the fluid up the arm, back into the body.

But, actively moving the fingers is probably the best way to remove edema.


Since you have some type of hand or wrist injury, which will slow down some of your rehab. But, you should be moving your fingers as much as possible. You should also be doing elbow motion. Moving the hand up and down. Up to your mouth and down till the elbow is straight. This may take a little while, but work on getting the elbow motion to as "normal" as possible.


As for shoulder motion. Again, since the humerus has been fixed, you should be able to start pendulum (Codman's) exercises. These are basically just getting the upper extremity swinging a little.

You lean over, putting your good hand on something stable. Let you injured arm hang limp at your side, always from the body. Then gently, get it swinging side to side, front and back, making the movements just a little bigger. Then try circles. Loosening up the shoulder motion.

These are usually the first shoulder exercises.


As to other shoulder exercises, that depends upon how well your fracture is healing. You do not want to put too much of a bending moment on the plate, till the fracture starts to show some healing (callus formation).

The plate and screws are just an internal splint. While is can take some stress, repented bending is not in it repertoire.


Thus, exercises which include actively (using your own muscles) moving the arm away from the body will have to be okayed by your surgeon.

Things which provide support for the arm, can probably be done. This includes things like wall walks and pulley exercises.

The wall walks are just standing at a wall, about a foot away, then putting your fingers on the wall, walk the fingers up the wall to head height to start. As you get more motion, you can go higher.

Do the wall walks standing straight in front of the wall, then standing to the side.

As your arm gets stronger, stand a little further away from the wall.


Pulley exercises require the equipment. This is an overhead pulley with a rope, with handles at each end. Grasping the handles in each hand, use the good hand to pull the injured arm up. You should not use any muscles in your injured arm, except to hold on to the pulley. You may have some problems doing this with your injured hand. But, it may actually be some therapy for your injured hand also.


There are some exercises with a cane, using the good hand/arm to move the injured one. But, these are a little more advanced and should be shown to you by a physical or occupational therapist.


So, you really need to find out from your surgeon how much activity you are allowed to perform.

As to the sling, if you are having discomfort in the fracture site when you do not use the sling, you should use the sling.

You may also find that you get really tired when you do not use the sling. So, you might want to try going without the sling for a while, but have it handy for when you get tired.


Again, would on finger motion. Get the edema out of your hand and arm. Work on elbow motion. Try some pendulum exercises, wall walks. Contact your surgeon for advice on how much activity you should be doing with your arm.

Good luck.

Hope your arm heals well.

Thank you very much for your help, I am going to contact the hospital tomorrow and try to get talking to the surgeon, It left me extremely frustrated last time. I have been maybe doing too much, I excerise the hand as much as possible as the radial nerve was damaged during surgery and my thumb and knuckles are still quite numb. Your time and advice is very much appreciated, Thank you

inpain45,

(Sorry about the typos in my previous posting, I should be proofed it better.)


Since you have a radial nerve palsy, you do definitely need to contact your surgeon.

Did you injury your hand/wrist or is the splint for the radial nerve palsy?


Therapy for radial nerve palsy is a little different from the regular therapy for just a humerus fracture. However, you can do the pendulum exercises for shoulder motion, so that you do not get a frozen shoulder. That would just be another problem you would have to deal with.

The wall walks may be a little bit of a problem for you to do. But, you might try them. If you have access to the overhead pulley, you might also try that to help with your shoulder motion.


With the radial nerve palsy, again, your therapy will be somewhat different. But, you do need to keep your fingers and wrist supple. Do as much active motion as you can with your fingers. You will probably have trouble extending the fingers (making them straight) and bringing your thumb and wrist up (extension).

You may have to use your other hand with this motion. I am unsure as to why you were told to keep the splint on at all times. Unless you had an injury to your hand/wrist.

Usually, the splint is to be on at all times, except for range of motion therapy and hygiene. It may be that they want you to come to the clinic for your therapy.



Usually, with radial nerve palsies, we placed our patients in a dynamic splint. It is a little bit bulky, as it has an outrigger, with little nylon lines, connected to rubber bands, that go down to the fingers and thumb, which have little leather loops around them. This is so the patient can actively flex the fingers and thumb down, but the rubber bands will bring them back up. This allows the patient to do a lot of activities, which they could not do before.


It may be that they are just waiting to see if your nerve wakes up some, before putting you in the big dynamic splint.



Anyways, hope you are doing well. Do contact your surgeon for advice. You may also want to contact the occupational therapy clinic for advice on range of motion exercises.

Good luck.

Hi Gaelic, once again thank you for the detailed help and information you have given, As I am at a loss as to what I should and shouldnt be doing. The radial nerve palsy was a result of the nerve being stretched during surgery, Im not sure what size the plateis or how many screws ther are but the scar starts from the joint at my elbow and finishes half way across my shoulder blade. I have been doing constant hand excersizes on my hand , Stretching my thumb to the base of my baby finger, stretching out my fingers and making pinching motions with play dough all advised by the O.T. My range of movement is quite good, just not much strength yet. as to my arm I have been using it as much as possible, I can sweep or hoover slowly and I can iron lifting the iron with my good hand and smoothing with my injuired arm, In saying that I am not sure whether I am doing more harm or good as the only advice I was given was for my hand. Anything I do with my arm does cause discomfort but I keep pushing myself. once again your advice would be very much appreciated.

Dear inpain 45

I agree with everything Gaelic has told you about the therapy exercises. My posts are found under Gingerchick67 if you'd like a little info about my injury. I have a plate and screws, too. I have just finished two weeks of therapy and will need three months more but I see improvement every day. Do not be discouraged!I was at first and Gaelic talked me down as well as my physical therapist. I am doing things I couldn't do last week and evn two days ago. You can do this! Chris(gingerchick67)

Welcome. I will see my surgeon this Tuesday Feb 14th, and with any luck the xray will show that my humerus is fusing together. Physio is slow. I still can't raise my arm up to my side or behind me and I'm stuck at 108deg in front.
I'll be 60 in April, but I don't have osteo. Just tend to fall wrong apparently.

Gaelic thanks for the info. It was very helpful and informative. I wrote down some things as a result to ask the Dr. on Thursday. I appreciate the opportunity to connect with others experiencing the same situation.I am in a full arm cast and thanks to you going to move those fingers. We will see what the Dr. says Thursday. Again thanks Gaelic!

Gaelic thanks for the info. It was very helpful and informative. I wrote down some things as a result to ask the Dr. on Thursday. I appreciate the opportunity to connect with others experiencing the same situation.I am in a full arm cast and thanks to you going to move those fingers. We will see what the Dr. says Thursday. Again thanks Gaelic!

Sandy hi and thanks for the welcome. I hope all goes well tomorrow. Let me know. Maybe I can post the same reply only once this time. Left handed is Not my strong suit!

Hi all
I broke my left humerus on 18th december 2011, it is a mid shaft spiral displaced fracture with fractures running down the bone & up into the shoulder joint. On my last appointment at fracture clinic they removed the cast and fitted me with a brace which allows me use of elbow but I cannnot straighten the arm yet. When they took cast off I can only lift my arm up about 15%. I have been off work 2 months now & next appointment with consultant is mid march. Last X-ray showed very little healing & only moderate re-alignment of break. My question is what sort of time frame am I looking at before I could be driving and cab return to work. I am lucky in that I have been doing a small amount of work from home on laptop and my company make my salary up to full pay for 6 months. But an idea of when my life might get back to something resembling normal, i.e., being able to drive, would be appreciated.

highgate,

Welcome to eHealth.

I posted messages to your other posts.

Again, welcome.

Sandy hi. How did your appointment go and can you drive?

I went to the Dr. on Thursday. They removed my hanging cast because it was pulling the bones too far apart. X-rays showed a setback in the bone angle so back into the hanging cast with a new angle and different weight proportions. The Dr. mentioned surgery several times if the bone angle does not resolve shortly.

This injury really lays you up for a long time it seems. I am only 3 weeks in but Dr. told me I will be lucky to be driving in 3 months if all goes well, but not to count on it or get my hopes up and it could be several months.

Highgate welcome. Hope you get some answers.

Hi Youngnbeautiful,

Hope that the repositioned hanging cast is starting to improve bone position for you & that you avoid surgery.

I am hopeful that the fact that my consultant has transitioned me to a humeral brace is a sign that I have started on the downward path of what is the worst injury I have ever had the misfortune to suffer. Thank god it was my non-dominant arm as otherwise I would have been so much worse off.

I have had some extremely helpful advice from Gaelic and am hopeful that when I go back in March things will still be showing signs of improvement & I'll be referred for physio.

My main downfall is my nicotine addiction which is very hard as the boredom intrinsic to being so immobilised does not make it any easier to stem the craving. Previously I've only had arthroscopic surgery for torn cartilege and by this amount of time I was back at work, driving and well into physio.

One thing is for sure I will never take my upper arm for granted again.

I BROKE MY LEFT HUMERIS ON 2/1/12. HAD PLATE W/ 18 SCREWS SURGICALLY PLACE ON 2/10. AM FEELING MORE IN CONTROL OF MY ARM DAILY BUT THE PAIN AND ACHINESS IS UNBELIEVABLE AT TIMES. HAVE BEEN OUT OF WORK FOR A MONTH AND WILL START PT IN WEEKS. WAS TOLD I WOULD NOT RECOVER FULLY MY RANGE OF MOTION.

GINGERCHICK67,

Welcome to eHealth. Hope you find the forums informative and supportive.

If you can, could you type in lower case, rather than in all CAPS? It is difficult to read and is usually taken as if you are shouting, when typing in all caps. If you have a vision problem requiring the all caps, that is okay, just let us know that is the reason for the all caps.


Sorry to hear about your injury. Hopefully, you will heal up just fine and can get on with your life.

Here in the beginning, while you are still in your sling, be sure to work on finger and wrist motion. You should be doing range of motion for the fingers and wrist every hour while you are awake. This will help to reduce any swelling or edema you may have in the hand. By using the muscles to move the fingers and wrist, it will help pump the venous blood and edema back into the body.

When your surgeon allows you to start doing elbow and shoulder motion, do try as hard as you can to do the exercises. Decreased shoulder motion is one of the most common problems have humerus fractures.

Some patients also develop a frozen shoulder. It is best to try to prevent this, rather than try to treat it later. It is a very difficult problem to treat. So, again, as soon as you are allowed to move, get into therapy and get those joints moving.

If you can get your joints moving, then you may be able to regain full mobility. But, yes, it is true that many patients do lose some motion in their shoulder after a humerus fracture, but not all do. Let's hope that you are in the group that gets all of their motion back.


Things you can do to help the fracture heal include eating a good diet with extra protein, calcium, vitamin D, and magnesium in it. If you smoke, quit. Nicotine is probably the one worst thing for healing tissues.


Good luck. Hang in there, it will get better.

Hello,Gaelic!

i type in all caps because I type faster since I only use one hand. Thank you for the advice. I move my arm on a regular basis by walking my fingers out in all directions as I sit on my bed or sofa. Before the accident I took calcium magnesium and several other vitamins and amino acids daily for years. Never smoked, don't drink, either. My surgeon showed me how much mobility i would regain and it was disheartening. I see him again on 3/5 to discuss pt and returning to work. I agree with some of the people whos posts I've read: worse pain ever. And I could not lie down on a bed for 22 days. sleeping was a nightmare. but about 4 days ago I slept in my daughter's bed because she has a frame and mine does not. Am able to rotate outward and then sit up while pushing off frame. I feel slightly off balance but i think that is because I fear falling again. Just gotta keep on keepin' on!

GINGERCHICK67,

Remember that surgeons will always give you the worst case scenario. That way, if you get more motion than expected, you will be happy. Surgeons are always very happy when patients show them up, and do better than predicted.


Since you are allowed to do shoulder motion, you might also want to do pendulum exercises (also called Codman's). While they are normally done totally passive, since you are allowed to use a little muscle around the shoulder, you can actually start the swinging with just a little muscles action. You can get videos and pictures of how to do these on the internet. They are great for getting range of motion of the glenohumeral joint going. They are essentially just leaning over, supporting yourself with your good hand on the arm of the couch, letting the bad arm hang free, and then gently swinging the arm to and fro, side to side, back and forth, and around in small circles. The motion arc gets bigger as you get more motion.


It is very common to feel off balance, when you cannot swing the arm like normal during walking. Our arms being able to swing during gait is actually very important for balance. So, once you get the rehab going more and you get back into the rhythm, you will feel more on balance.


So, just keep going. It does get better and better as the tissues and bone heal. And show your surgeon up, get more motion than expected. Don't give up when you reach the expected amount, just keep going and get as much as you can.

Good luck. Oh, and you type very well for a one armed typer.

Great forum to find! I’ve read every page and really appreciate all the good stuff written here.

I fractured my humerus, spiral fracture, 29 Oct 2011, a rather graceful fall from a very big horse at speed. I’m 55 years old, non-smoker, non-drinker, healthy lifestyle, great diet, some asthma. I was lucky, I thought, to only break one bone. My arm swelled up to the size of a rugby ball (I live in New Zealand). I enjoyed lots of morphine after the adrenaline wore off, was trussed up with a pendulum plaster for the first week, then a clamp until 8 weeks. At that time I was feeling great so took the clamp off for a spell each day. My doc saw this and perhaps didn’t look closely enough at the x-rays, suggested I didn’t need the clamp anymore.

I started physio and worked diligently at my exercises. Recovered heaps of movement, not much pain and feeling good. Only thing was, the fracture was still wobbly. It sometimes looked as though I had two elbows except the upper arm “elbow” pointed in whilst the real one pointed back. I figured this was not good, but was told not to worry by the physio, it was my imagination apparently. Soon became painful. At 12 weeks I took myself back to the ortho clinic to suggest that things weren’t as they should be. The doc I saw this time said that there was almost no healing. I was totally shocked but it was pretty obvious. Now at 4 months, I’ve had the clamp on 24/7 for the last 4 weeks, my next appointment is in a week. I’ve been freaking out that they will want to do surgery. I definitely don’t want anyone’s knife near me but was losing hope until I read this forum.

So thank you for this forum. I am feeling much more relaxed. I’m prepared to take as long as it needs to heal naturally. I’m checking my diet, seeing Osteopaths, Bodytalk and homoeopathy. All contributing to sorting out the back pain from limited movement. My biggest problem is a stiffening of my back as I work on the pc all day. Have to break every 30 minutes to stand and stretch. I seem to be managing. It helps if I go for even a short walk each day. I also sustained a lot of spine compression just prior to the fall - I was learning to rise on the trot and wasn’t managing too well. My spine was getting a serious jolting for about 10 minutes as I hit the saddle just as the horse rose. I’ll stick to natural horsemanship from now on. This classical stuff doesn’t make a lot of sense.

So far no radial nerve involvement thank goodness.

I can’t drive. I love the suggestion to hire a care for a disabled driver but have become quite good at managing all my chores with a couple of taxi trips each week. My carbon footprint has improved. I’ve even given my car away for the few months until I recover. Managing the household chores has been a bit difficult and I’ve had to ask my son to live with his Dad for a spell. It’s hard to prepare meals with limited use of my left arm. That said, I have pretty good movement but don’t want to load it up with too much stress.

This forum has given me the impression that there is no real timeframe for healing to get committed to. That’s a relief. I was worried that it all should have healed by now.

I’ve become pretty comfortable in the clamp. I take it off a couple of times each day to rest my arm, give it a gentle massage, take a shower. With the mind at ease I hope to be able to do the distance.

Just seen the Doc again - now 18 weeks since injury. No callous formation apparent. They are all keen to go ahead with pins and plate. They say that it will never heal if I don't go for the surgery. This seems to conflict with what I'm reading here. Can you tell me just how likely is it that a bone will heal in two separate pieces and not join eventually? Thank you.

BrokeinToo,

Four and a half months is a pretty good effort at trying to get a humerus to heal. Though, by definition, a fracture is not a nonunion till six months have gone by, if there is NO callus formation by 4 1/2 months, the writing may be on the wall.

You could try a bone stimulator, to see if you can get the bone to start laying down some callus in the next six weeks or so, if you want to try not having surgery.

But, if you do not start to show some callus in the next few weeks, you are probably going to have to have some help getting that bone to heal. You will probably have to have some bone graft put in, and the fracture stabilized.

(If you smoke, you might want to quit till the bone is healed. If you don't smoke, disregard.)


Good luck.

Thank you Gaelic.
That answers my question. They are talking about some artificial morphogenic bone material instead of a graft. Can you tell me anything about that? The doc said it was optional but to my way of thinking, if it's not healing naturally, why would it suddenly want to heal with a pin and plate. It makes sense that a graft of some sort might be necessary even though I really don't want any intervention at all least of all some foreign protein inserted. They didn't offer a bone stimulator. Where or how do I investigate that? Ask Mr Google I guess.
Thank you for your support on this forum.

BrokeinToo,

A bone stimulator is a small device that is placed on the outside of the skin, to try to stimulate the bone to heal. There are basically three different types, depending upon what type of field they use: ultrasound, electrical, magnetic (or combination electromagnetic). The device is placed over the fracture for several minutes a day and it is something that can be used at home.

Yes, you can Google "bone stimulators" and probably find more information that you really want.


In terms of surgery for a nonunion, the plate (held on with screws) actually doesn't heal the fracture. It is just placed to stabilize the fracture, as motion will sometimes keep a fracture from healing. But, usually, if the fracture has become a nonunion, it is going to need some biological help to jump start the healing process. That is where the bone graft comes in.

When a fracture goes on to a nonunion, the area between the two ends of the bone is not just like it was when it was first broken. The bleeding that occurred at the time of the injury has been consolidated and the body has put collagen fibers in there (fibrous tissue). This is a rubbery type of tissue.

So, during the surgery, this fibrous tissue has to be removed and the bone ends freshened up (cleaned up) back to raw bleeding bone again. The bone ends are then stabilized with a plate (held on with screws). The area of the fracture and under the plate is packed with bone graft.

Bone graft can be of two types: autologous graft (your own cancellous bone) or allograft (harvested bone or artificial bone).

The autologous graft (also called autograft) is usually taken from the iliac crest (pelvic crest). So, you have another surgical site on your pelvic brim. Some patients say that the graft site is more uncomfortable than the nonunion surgery site. But, it is the best graft material there is.

Your own bone graft provides both structural support and osteogenic cells. Some the cancellous bone (spongy bone) will be harvested, which contains the bone marrow. The marrow has the cells which produce bone (osteoblasts). Thus, when the cancellous bone is packed into the fracture nonunion site it brings in this scaffolding for the new bone to grow on and also the cells needed to jump start the healing.


The allogous graft, also called allograft, again is either harvested bone or artificial bone.

Harvested bone basically only provides the scaffolding properties, because it has to be cleaned of any cells from the person that donated the bone.

There are several different types of artificial bone. They even used coral at one time. The artificial bone also only provides the scaffolding.

Thus, the allograft is usually used with a material such as BMP (bone morphogenic protein) to help with the biological activity.


So, these are things to really thoroughly discuss with your surgeon.

The stimulator is worth a try. There is research both ways, saying that it really works and that it is not much better than a placebo. If it really worked well every time, it would be used all the time. So, again, it is worth a try, if it works, great. If it doesn't, you haven't burned any bridges, as it is noninvasive.

As to the bone graft type, discuss it with your surgeon. Some patients do not want to put up with a second surgical site and the discomfort that goes with it. So, they will go with the allograft.

Others, do not want anything artificial used, so they stay with the autograft.

It is really up to you, based on the information that your surgeon provides you.


Wishing you the best. Good luck.

Thank you Gaelic.

That's very clear. I understand perfectly. I very much appreciate your detailed response.

Kind regards

hi everyone. ibroke at mid-shaft on feb 19th riding our new horse bareback. its two weeks now, they tried to rebrake it last week and re-set to no avail. transvers and a bit out of place still. i was in u slab, 9 days later in a simento brace. iam in australia gettg treatmnt from registars or students...scarry...public health. i have so many tearful days, pain, i have 5 children under 7 years old...but don't forget the Lord in all of this, pleas let us pray 4 eachother.

HI
I broke my humerus in April 09, tripped over a bar lying on the ground at my work I did not break any skin but the break was very severe. The bottom part actually pushed up and wedge into the top part.

They did not operate and they were amazed that I did not pass out, they put what they call a backslab on my arm and they did this the day after I broke it! Which the doctor that had to fit the brace was not happy about doing it to me so early.

I could not drive for 6 months, 12 months after I had to have shoulder reconstruction, I can only lift my arm 90 degrees horizontal with my shoulder. I also had a lot of physio after both both. This has been life changing in the way I do things at home, driving etc. I have a real fear of falling and have been told that this is the best that it will get.

Regards Showtime!

Don't wait for surgery if you are found to have a non-union. I fractured my humerus in 3 places (yep, another fall from a horse) at 51 yrs old in Oct 2007. One portion of the butterfly facture mended, but even with an intermeduary? rod/nail the other 2 breaks never mended. Surgeons never want to admit failure I found. My original surgeon said "learn to live with it" you have 60% use...it was years later, 2012, the scar tissue encapsulated my radial nerve anyway and my hand curled into a claw. Enter the miracle worker, Dr. James Stannard, at the Univ of Missouri Othopedics in Columbia, MO. It was worth the trip. 7 weeks out, I am feeling better than I ever dreamed, and am improving each day. He removed IM rod/nail, used humerus spongy bone and BMP, filled in deficits, and plated and screwed. Don't wait if you have failed to heal, soooo not worth it. Also, Bone Stimulators on EBay. Just beware that the batteries on the ultrasonic's have a limited life and they will be good for only so many uses. Ask the seller questions about remaining time.

Oops. They used marrow (spongy bone) from my femur and put it into my humerus.

broke my humerous in 3 places spiral fracture feb 12/12 right -handed & broke right arm, it has been challenging & a test of patience & preserverance to say the least ..wet wipes are truly awesome.. reading these posts are encouraging to know that others are goin thru similar experiences ..comforting if that can be said that what your goin through is not isolated. 9th week been out of brace for 2 weeks & am working through moderate pain to increase mobility & strength in arm..this experience taught me a greater respect to those individuals who suffer from physical injuries & disabilities. A simple thing as simple as buttoning your pants & washing yourself is such a challenge good luck to everyone out there

Hello folks. I'm new here and I've only just found your forum.
Ifoud it because having broken my humerus about 7 weeks ago, I've been looking online for 'what's what'.Broke it just below the shoulder joint and the very first doctor who saw it said if you have to have a fracture, that's the sort to have.
the 2nd doc said he expected it to heal in 3 months.
They just put a sling on it and started me on phsio.
I think that the physio was perhaps a bit too vigorous because a subsequent Xray shows that the fracture is worse now than it was at the beginning.
A big factor against me is age. I'm 78.
Anyway, I'm going to see a specialist who I believe will tell me about the pros and cons of pinning.
I'm not optimistic.
Please excuse the typos. I'm still learning to type with one hand.











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It's broken about there

This is all very scary to read. My 11 year old daughter broke her humerus about 6 days ago in almost the same spot as this picture. Her break did not go all the way through but about half way across starting taking a diagonal path downward. When I saw the xray the bone was slightly protruded outward and you could slightly feel it when you touch the shoulder. Emergency room told us it would heal fine and sent her home with a sling. I took her the next day for a second opinion and was told almost the same thing and she was given an immobilizer. It broke through the growth plate and they said that surgery may stump her growth. She goes back tomorrow but this whole thing is making me nervous. I just don't understand how such a break can heal without some sort of help. Especially when it is so easy for her to accidently move it without it being in some sort of a cast.

anxiousmama,

Children's fractures are much different from those in adults. Kids have great potential for remodeling of the bone, as well as other physiologically different properties of the bone.

It sounds from your description, that your daughter has a Salter-Harris II fracture of the surgical neck of the humerus. A common place for fractures of the humerus in children.

It does involve the physeal plate (growth plate), and as such there is a very small chance of growth disturbance from the fracture. But, this is very small.

And as you have been told, the more the physis is messed around with (multiple closed reduction attempts, surgical intervention, etc) the higher the chance of growth plate disturbances.

Because of the great potential for remodeling, kids' fractures do not have to be reduced an anatomically as adults have to be. Adults do not have any growth left and as such, their remodeling of fractures is very limited.

Children’s' bones also have very thick periosteums. The periosteum is the soft tissue sheath that covers the bone. This tissue has blood vessels and nerves in it. But, in children, since it is so thick, it helps hold the fracture fragments in place. Also, children's fractures around the surgical neck of the humerus have muscles that hold the fragments togethers. Also, these fractures tend to be impacted, which also helps hold the fracture. Thus, usually these fractures can be treated with a sling or cuff-n-collar. Occasionally a shoulder immobilizer will be used. And, on rare occasion, an "elephant ear splint" will be employed. Most of the time, a bulky plaster splint is just more uncomfortable than it is effective. They are rarely needed in this type of fracture.

Children’s' bones also have a higher percentage of cartilage in them, than adult bone. Thus, kids' bones tend to buckle and incompletely break. Sort of like trying to break a green piece of wood. It doesn't snap sharply, but rather has an incomplete type of break, a "greenstick fracture". This is also a term used in kids' fractures, when the break is not complete.


So, again, most kids' fractures heal very nicely, without much intervention at all. Which is why it is so nice to treat children's fractures, they almost universally heal without problems. Kids lay down callus (new bone formation) quickly and can remodel almost any angulation with growth. The younger the child, the more potential for remodeling.

Again, adult fractures are much different than children’s'. The discussions in this forum are about adult fractures. Totally different animals. Your daughter's fracture should heal nicely.

Children also usually do not have the problems with stiffness that is seen in adults. They usually have a little decreased range of motion after the immobilization is discontinued, but they tend to play themselves back into shape. It is indeed rare for a child to have problems with long term stiffness.


Good luck. Give your daughter a lot of love. Wishing you both the best.

Thank you for all the helpful information. We go today for a check up. It's been almost a week and a half. I hope the xray shows improvement.

anxiousmama,

There may not be any callus formation visible at just a week out from the injury. So, don't get too excited if there is not a whole lot of change from the initial x-ray.

The clinical course is actually more important at this point. Your daughter should have less pain in the fracture area. This is a sign that the body has started to "glue" the bone back together.

The first thing the body lays down is called osteoid. It is the "glue" to hold the fracture fragments together. This begins as soon as the bone stops bleeding, which is usually within the first 48 hours.

Then, the body will start to put calcium in the osteoid. This becomes the callus (new bone formation). So, until the body actually starts to put some calcium down, you will not see it on the x-ray.

Then, the callus will form all around the fracture. The body will lay down a big glob of it. Then, over time, it will take some callus off here and there, to make the bone look straight again. This occurs mainly with growth, so it can take several months to completely remodel a bone. But, it will be strong enough to go about all of the usual kid activities in around 6 weeks (give or take).

So, your little one should work on moving the fingers and wrist around. This helps keep them from swelling and getting stiff/sore.

As the fracture heals, the discomfort becomes less and less. Kids are great, in that if something hurts to do, they usually won't do it. So, the chance of kids doing something they aren't supposed to do is very small. When it doesn't hurt anymore, then they usually start their own therapy. Most kids have trouble just sitting around, taking it easy.


So, again, your daughter will most likely be fine. This will probably be harder on you, than it will be on her.


Good luck.

Yes it has been very hard on me. I am pretty broken hearted over the whole thing but she is being such a trooper. Your comments help a great deal. And you are correct. Not much healing showed on the xray but they did say it looks fine. They wanted to make sure that nothing had shifted which it hasn't and she is definitely having less pain. She has no problem moving her hand or elbow. Just the shoulder itself. Going back in two weeks.

Sounds great. Kids are usually wonderful patients, they heal so nicely.

As you have noticed, if kids don't hurt, they move. It is often very difficult to get adults to even try to move their fingers, wrist, and elbow after humerus fractures, because they are afraid of doing something to the fracture. But, kids, if they don't have a lot of pain, you can't keep they down.

Hopefully, she will still have some time to play during the summer before school starts again.

Hang in there. Good luck.

Yes it has been very hard on me. I am pretty broken hearted over the whole thing but she is being such a trooper. Your comments help a great deal. And you are correct. Not much healing showed on the xray but they did say it looks fine. They wanted to make sure that nothing had shifted which it hasn't and she is definitely having less pain. She has no problem moving her hand or elbow. Just the shoulder itself. Going back in two weeks.

I tripped and fell on my right elbow back in November of 2009 and suffered a distal humerus fracture..that was the most painful thing in my life. My ortho surgeon said he was able to put most of the pieces back but there was debris all thru the joint (minor things lift pcs of cartilage) so after surgery, I ended up with 2 plates up both sides of the humerus,several screws, a pin in the ulna and bone graft. I spent 6 months in PT and have gotten approx 60% range of motion. I can't extend my arm out completely which makes it interesting to shake hands but since I am left handed, I get by OK.
It's interesting to read about other people's experiences. I hope you all have good recoveries

I haven't read all of the responses but the ones I have read are very informative. Thanks for this thread.

I broke my humerus in a few places a couple of inches above the elbow just under two weeks ago. I was given the choice of surgery or let it heal naturally. They laid out the pro's and con's of each and the time factor was what made me elect for surgery since they said it would be at least 12 weeks that way. I understood the risk of nerve damage and paralysis of the arm/hand with surgery but had a good feeling about the surgeons and the hospital I was at.

They put a 12" plate and I think 10 screws in there to hold it all together. That was 10 days ago, I'm typing with both hands and have good range of movement of the hand and fingers. I cannot yet do a full bicep curl or extension but I know it's early days and I haven't started physio yet. On Monday I'll have the sutures taken out and I'll really feel like progress is being made.

I don't think I have any questions but felt like my experience may help someone else. Oh one thing I should mention, when I rotate my wrist there's sometimes a clicking feeling coming from the elbow, it's not painful more uncomfortable. I'm hopeful this will go away in time.

funnybreak,

When you have your sutures removed, mention the click in the elbow. It should be evaluated. There are a few things that can cause this, but one that does need to be checked for is a fracture of the radial head. It is not uncommon for patients to have other injuries, when they have had a significant fracture. The main injury can sometimes mask another injury. Now that the humerus fracture has been stabilized and is on the mend, the other fracture may become more noticeable.

So, again, there are other things that can cause clicking, but the fracture of the radial head should be ruled out. So mention it when you have your sutures removed.

Keep working on the finger and wrist motion. They are extremely important to reduce the chances of developing stiffness and they also help to pump blood and edema back into the body.

Good luck. Hope your therapy continues to do well. Wishing you the best.

Thanks Gaelic, I'll be sure to do that I just read back my post and a bit of it doesn't make sense.

It would have been at least 12 weeks if I didn't elect to have surgery...

Hi Gaelic and others,
I have broken my humerus seven weeks ago and that is healing well (shoulder moves well, but still can't raise my arm over my head?) However, I do have the radial head fracture you mentioned above as well. Unable to straighten my arm and the elbow does click. Anything you can recommend for treating this condition? I meet with a specialist soon and know he will want to do surgery. Any negatives if I don't have the surgery you can think of? I appreciate your help.
Ryan