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Humerus fracture:some questions

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I am a 37 years old woman in good health, apart some mild hypothyroidism that is being treated.Three weeks ago I had surgery (nailing) done to fix a displaced proximal humerus fracture. The doctor took an x-ray yesterday but he didnt tell me anything about bone formation.....I saw it and the fracture wasnt really straight but a little bit still displaced around the needle inserted in the bone....the doctor just told me to start physiotherapy as soon as possible. I have been doing pendulum exercises since the first day post op, so, my questions are:

what kind of physio should I start now, strenghtening exercises?is it not too early?
is there any risk that with movements the fracture can become more displaced and not heal properly?
in the case the bone grows back not very straight, will I have impaired movements?
when is the bone going to grow back completely?

sorry about all these questions but I am very worried and I didnt received much support and info from my doctor.
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First Helper User Profile Gaelic
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replied February 2nd, 2012
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Laurap74,

You do not say how you are doing clinically. Is the pain at the fracture site decreasing, are the Codman's exercises getting easier to do, are you more comfortable? These are all signs that the fracture is probably doing very well.

At three weeks, you may see the beginnings of fluffy callus around a fracture of the humerus. But it is not uncommon, to not see any callus at this time. If you are clinically felling better, then there is osteoid being laid down around the fracture. Osteoid is the first stage of callus formation. It is what makes a fracture "sticky".


As to the alignment, since you have an intramedullary (IM) nail (which is the hardware that you have in place), it is within the acceptable range. The bone ends of the humerus do not need to be anatomically lined up. Since there is so much motion within the shoulder joint, slight offset and angulation is very acceptable.


If you can, you should see a physical therapist, so that the therapist can show you the proper way to do your exercises.

You should continue to warm up with the Codman's pendulum exercises. But, you can start doing some assisted arm lifts. You do not want to lift the arm, straight out, as that would put a large bending moment on the fracture site. If you did that, you would probably have some pain at the fracture site, right now. So, pain at the fracture site is a good guideline.

Wall walks are a good exercise to start with. Standing close to the wall, using the fingers, walk the arm up the wall. As long as you are touching the wall, the arm is supported. Doing them facing the wall, and standing with your side to the wall.

You can lay on the floor, with the arm supported by the floor, move the arm away from the body, going higher and higher each time. Sort of like making snow angels.

You can use a cane or stick, and grasping it with both hands, use the good arm to help move the bad arm.

If you have access to a pool, that is great exercises for fracture patients. You can get in the water and let the water support the arm. You can then move the arm in all directions.

Always, let pain be your guide. You are expected to have some soreness in the shoulder joint and muscles, but if you have sharp, intense pain directly at the fracture site, you need to back off a little.


Putting stress on the fracture site can actually stimulate the bone to heal better. This is Wolff's Law: bone will respond to the stresses applied to it. But, as with everything, there is a happy medium. However, it is difficult to put too much stress on the fracture, without the site hurting.


It usually take about 6-10 weeks for a humerus fracture to unite. This is the time for bone healing only. That does not include the time it will take for rehabilitition.


Again, you should see a physical therapist at least once, to get the proper exercises. If you think you are going to have trouble doing the exercises on your own, then set up regular therapy sessions, till you have regained more confidence.


Also, if you have any specific concerns about your case, you will need to discuss them with your surgeon. If you have questions, write them down, so you can remember to ask the surgeon.

Good luck.
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replied February 3rd, 2012
Hi Gaelic & Laura
I am a 38 year old woman and relatively healthy, I fell on New Years Eve jumping over a little fence!! I have a mid-shaft humerus break, it is complete break so the bones do not touch at all. It will be 5 weeks tomorrow and it has been the worst experience of my life, now I know there are worse things Smile, I just never realised how debilitating a broken arm could be, someone has pressed pause on my life!!!

Gaelic, I have read all of your really helpful replies on the previous threads relating to broken humerus and only for those I would have no real understanding of the healing process, so thank you so much. (I am a smoker, really trying to give up completely, have cut down considerably) I do have a couple of questions! I am now entering my 6th week and will not be xrayed for 2 more weeks. My consultant was very pleased with my last x-ray 2 weeks ago, he said the bone alignment is good, no sign of callus forming at that stage. We discussed an operation and he categorically ruled it out and will only consider this option after 3 months if there is non-union.

On week one my arm was set in a heavy plaster from wrist to elbow, this was removed on week 2 and I am now in a brace. Each week I go back to clinic to have my armed cleaned and brace tightened. I have a foam sling on all of the time. The clicking of the bone has stopped, apart of when I am in a car travelling Sad, really is an awful sensation. The muscle spasms have also reduced and the pain has eased. I am lucky to have no nerve damage so I have full movement of wrist and fingers.

However, I have been not given any exercises to do? apart from stress ball for the hand and wrist mobility. If the arm swings away from my body is it agony, I do try to move the arm up and down with my other hand. I have been told that I will have the brace for 3 months. I am concerned from reading the advice you have given that I should be doing more? Also, last week a nasty itchy rash like hives, or sores, pus like, have formed under the brace, the nurses don't think it’s a problem, is this normal? I had arm cleaned and brace tightened today and the arm is still very swollen, bruised and the rash is very angry. I was advised not to take anti-inflammatory pain killers, but I am wondering if I can take antihistamines? I am so worried rash will get infected.
I would also like to get back to some physical activity, I am an avid gym goer, however as I cannot drive, I can’t get there! if I go out to walk I am concerned that I might fall over and I'll end up back to square one! Nervous wreck lol…. My last question is, would it be ok for me to knit?
Any advice would be greatly appreciated Smile Thanks
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replied February 3rd, 2012
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DubGirl,

Well, I may not get to all of your questions, but I'll try. The fact that the fracture is no longer clicking is a very good sign. That means that the ends of the bones have been "glued" together with some osteoid. The osteoid is the first stage of callus formation, before it is calcified.


The forming of osteoid and callus is why NSAIDs are not recommended. Inflammation is the first stage of the healing process. So, the antiinflammatories can disrupt the inflammation, thus slowing down the formation of callus, and causing the bone healing to be prolonged.


The rash under the brace can be from several things. It is not uncommon to get a fungal type of skin infection, due to the sweating under the orthoplast brace. It can look really red, be kind of raised, and be weepy/moist. This usually responds to the antifungal creams, like clotrimazole. You should also be using stockinet under the brace, between the brace and the skin. The orthoplast really should not be placed directly on the skin. At this stage, if you have some help at home (and maybe even if you don't), you could go to adjusting the brace yourself. In some cases, the surgeon will allow the patient to get in the shower without the brace; really clean the area, let it dry completely, put some powder on the arm, put the stockinet on, then reapply the brace. (It helps to have a shower chair available for the first few times you shower.) But, in any case, if you have a significant rash, the area needs to be clean much more frequently, sometimes daily. Contact the nurse and ask about it, especially if it is not getting a whole lot better. Antihistamines are okay. But, they can cause sedation, so be careful.


On the smoking issue, I know it is really difficult to quit. But, if you can quit, at least till the fracture is united, it would really help. Nicotine is very detrimental to the newly formed blood vessels in the callus formation. It also affects all of the small vessels in the body. So, every time you smoke, it basically shuts down the blood supply to the new bone, and as a result, no oxygen is getting to the area. Again, I know it is very hard, but do try.


As to what exercises to do, it would be really helpful if you can see a physical therapist, at least once, to make sure you know how to do the exercises.

The problem with your fracture, since it is being treated with a co-apt splint and not internal fixation, is it cannot be subjected to any bending moments. Any activity that would cause the arm to bend at the fracture site, like holding the arm out in front of your, with the elbow straight. You would know if you put a bending moment (stress) on the fracture, it would probably hurt. Right now, the fracture is "sticky" and healing, but the callus has not yet consolidated into a solid, hard mass.

So, what is emphasized at this time is finger, wrist, and elbow motion. Shoulder pendulum exercises (Codman's) can probably be added in also. You can do the finger and wrist activities in the sling. A stress ball is okay, if it is very soft, and allows you to get the finger tips down into the palm. TheraPutty is actually better, because it allows full range of motion of the fingers. However, the "six pack" of finger motion is the best thing to do for the fingers. If you Google “six pack of finger range of motion” you will get several links explaining how to do them.

With the wrist, go side to side, up and down, and around in circles. You can use a can of soup in the hand to help build strength in the wrist. Or do the motions holding onto a hammer, in the center of the handle first, then later at the end.

The elbow is a little trickier, but it can be done. Take the forearm out of the sling. Use the opposite hand to hold the injured arm against the chest wall. Then you can actively move the elbow up and down, slowly and gently, in front of the body. By doing the exercises actively (using the muscles), it will not only help with motion, but will help build strength.

Now, for shoulder motion. You can actually do the pendulum exercises in the sling at first. Again, it would help to have a therapist show you, but you can see videos on the internet. These are basically done by standing next to a stable table or back of the couch. Lean forward slightly, placing the good hand on the table/back of couch. Allow gravity to move the injured arm away from the body. In classic pendulum exercises, the arm is then relaxed, and using the body and legs, the arm is swung back and forth, side to side, and around in circles. This gets the motion in the shoulder going. However, if you are doing okay, you can use some muscle power around the shoulder to move the arm also.

Right now, that is about all you can do. All of the other shoulder rehab exercises put bending moments on the arm. However, knitting would be great exercise for your fingers and wrists. You can hold the yarn in your lap, but you may have to adjust your upper arm just a little, so you can get your hands in workable positions.


So, it sounds like the fracture is healing. You will have to wait till your next appointment to see how well.

Good luck. Wishing you the best.
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replied February 4th, 2012
Hi Gaelic,

Thank you so much for your detailed advice. I started the exercises today:-) and the knitting...which is my alternative vice to smoking, and the reason I started knitting in the first place! I do have a stocking under the brace, I was advised not to take it off, only to tighten it, I will ask the nurse next week if I can, so that I can treat the rash.

Thanks, enjoy your weekend Smile
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replied July 10th, 2012
rash
use Hibiclens on the rash (ask at your local pharmacy) - it wiil take a few days for big improvement but it will help it clear up completely...

I don't know anything about the brace but you need something between arm and brace preferably cotton to soak up any sweat to prevent further rash problems if feasible.
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replied February 3rd, 2012
Dear Gaelic,
thank you so much for your very informative answer. I will try to see a physiotherapist soon so to start a program of rehabilitation.

I have been signed off work for 6 weeks now, do you think I am likely to be off more time?how much does it take for rehabilitation more or less? I am a microbiologist and I work in a lab
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replied February 3rd, 2012
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Laura,

It is always hard to predict how long a patient will be out of work. Return to work depends on a lot of factors, not all of which are physical, nor even medically related.

Besides the obvious things like fracture pattern, how stoutly the fracture was fixed, age, overall general health status, what type of work, demands of occupation, etc, there are also things like motivation, job satisfaction, independent working level, etc. This is not to say that these will be of any significance in your particular case, they are just listed to show how intricate the problem actually is.


In concrete aspects, you will not be able to do any lifting for several more weeks. This includes lifting just the arm, away from the body. Not knowing exactly what you do (ie do you do mostly research, working on the computer, basically sedentary clerical type work OR do you actually have to do plating of samples, collecting samples, staining of slides, use of microscope, lifting plates in and out of the incubator, etc), it is hard to give you good estimate.

If you can work in close to the body, basically keeping the upper arm next to the chest wall and the elbow bent up (sort of like when you are in a sling), then you could return to work as soon as the discomfort allows you to. But, if you are going to have to reach across the bench to plate specimens, then you are going to be a few more weeks out of work.


This is something to discuss with your therapist or surgeon. Once you have started therapy, you will get a better idea of how much you can actually do.

Good luck.
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replied February 10th, 2013
Hi everyone
It will be three weeks tomorrow since I broke mid shaft humerus. I am finding it very painful and mt lower arm and hand are tender to touch and very swollen all the time. I had an X-ray 1 week after the initial injury and then told I wouldn't need to be seen for another month. I am a bit worried as it seems to be getting worse.....I can't feel bones moving anymore but the pain and swelling are not subsiding. I am trrying to move my wrist as much as I can. I feel I should return to fracture clinic but don't want to appear to be making a fuss over nothing....any advice?
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replied February 10th, 2013
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mumbulance,

You really need to work on getting the swelling down in your hand and fingers. This can really affect how you do after the fracture heals.

If it very difficult to elevate the hand significantly with a humerus fracture, but you can work on finger and wrist range of motion several times a day. With the finger motion, the forearm muscles are activated, which will help in pushing the edema back up the arm into the body core.

You should Google "six pack finger exercises". This will give you several links to articles and videos on how to properly do finger exercises. Remember, it is not "just a finger". Finger function is very important to overall upper extremity functioning. Again, it is extremely important to get the swelling down and to get your finger and wrist motion going. You should probably do the finger exercises every hour while you are awake.

It may be somewhat uncomfortable to get your fingers moving at first, but as you get the swelling down and motion going, it will actually become easier and easier.

Again, it is better to try to prevent as much stiffness as possible, than to try to treat it later. Now is the time to work on the fingers.


Since you can no longer feel the bones clicking in the arm, that means that the fracture is healing. The body will lay down osteoid (the soft tissue matrix of bone) around a fracture in the first 10 days or so after the injury. The osteoid will "glue" the fracture together. Then the body will begin to calcify the osteoid, making callus (new bone formation).


Again, work on getting the swelling and edema down now. Get the six pack of finger exercises and do them regularly during the day.

Pretty soon, you will need to start working on shoulder motion. Usually, with midshaft humerus fractures, we start patients on Codman's pendulum exercises as soon as possible, but by the second week as least. But, ask your surgeon as to when he/she wants you to begin the pendulum exercises for the shoulder. Again, you want to try to prevent a frozen shoulder, than to try to treat it later.


Good luck. Hang in there. If should start to get better, gradually. But, do work on getting the swelling down in your hand, it is extremely important.
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replied June 19th, 2013
spiral humerus fracture
Its been three weeks since I've broken my arm. 1st week I've had a full are cast and sling. 2nd week I got the correct brace. I have had tremendous swelling of my lower arm and hand. It just went down yesterday. My arm really doesn't hurt any more besides when I lay down for bed it starts to feel very stiff. When I move it I can feel and hear my bone clicking. I am worried that my btone stitll haven't grown back together. Although I can move my arm a lot better I am still having a hard time lifting my arm also I have more pain in my elbow than where the fracture is. Why is that? And my arm from my elbow is kind of stuck in an L position will it grow back that way or will it straighten itself out as it heals?
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replied June 19th, 2013
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tiffany2863,

It usually takes around 6-8 weeks for a midshaft humerus fracture to unite. This is just the time that is required for the bone to heal, and does not include the time for rehabilitation of the upper extremity.


So, it would not be expected for you to have "healed" the fracture yet, just being three weeks out from your injury. You have probably started to lay down some osteoid around the fracture site. Osteoid is the soft tissue matrix of bone. It will sort of "glue" the fracture fragments together. As this occurs, there is less motion at the fracture, and as a result, the discomfort about the fracture will also decrease. Once the osteoid has been laid down, the body will begin to put calcium into it. This is the formation of callus (new bone).

The "clicking" at the fracture site is from movement of the fragments against each other. Again, as the body heals the fracture, this sensation will go away. As long as you do not have any significant discomfort associated with the clicking, there is nothing to worry about. The clicking is actually quite common and is not unexpected.


Unfortunately, when a patient is not using an extremity, swelling will often occur. The venous blood, lymphatic fluid, and edema all require the action of the muscles to help pump them back towards the body core. Elevation of the hand will also help move the fluids back to the body, but this is not really feasible in a patient with a humerus fracture. So, to help with your swelling, you need to do finger, wrist, and elbow range of motion exercises. Again, the muscle action will help pump the fluids back to the body.

You can Google "six pack finger exercises" and get several links to articles and videos on how to properly do finger range of motion exercises. For the wrist, you just need to flex, extend, and circumduct (move in circles) the wrist. The elbow is a bit more difficult, but not impossible. You should stabilize the upper arm by holding the arm against the chest wall using your good hand. Once the upper arm is stabilized, you can then flex and extend the elbow. You can do the elbow range of motion either standing up or lying down. Basically, you "rub your belly" with your hand, to do the elbow range of motion. You also need to work on prono-supination of the forearm. This is basically just rotating the forearm, so the palm is up, then down.

You might also ask your surgeon if you can start to do Codman's pendulum exercises with the injured shoulder. These will help reduce the changes of developing a frozen shoulder. The Codman's exercises can be done with the fracture brace on (and even with the forearm in a sling, if necessary).


As to "lifting your arm", you may not want to do this type of activity, until the bone is basically healed. When a patient lifts the arm (moves the arm away from the body, either in front or to the side) without the hand being supported, this puts a significant "bending moment" at the fracture site. So, in humerus fractures, once the surgeon allows the patient to start doing therapy exercises, the type of exercises which are recommended are what are called "closed chain" exercises. These exercises include such things as "wall walks", where you stand next to a wall and "walk" your hand up the wall by walking up the wall with the fingers. You do this standing first facing the wall, then next having the wall to your side (so that you do forward elevation (facing wall) and abduction (wall to the side)). These exercises are called closed chain because the hand is always supported in some manner.

Another rehab exercise for humerus fractures (and shoulder injuries) is to use a rope and pulley set-up. In these, the good hand helps to move the injured one, with the use of the rope and pulley,.

There is also a set of exercises for humerus fractures and shoulder injuries, which uses a walking stick or cane. Again, the good arm helps move the injured one. You can speak with a physical therapist on how to do these exercises, to Google the topic.


Once the fracture is united, you might want to look into getting into a pool for water exercises. The warmth of the water makes the tissues more pliable and stretchable. The buoyancy of the water makes it easier to lift and move the shoulder, and the water will support the arm. Also, water exercises are very safe, as it is impossible to "fall down" in the water.


As to the position of the humerus fracture, adults usually do not remodel a fracture very much. As opposed to children, who have the capacity to greatly remodel fractures, adults just do not have this capacity. The body will remodel the fracture somewhat, where the fragment edges are smoothed and rounded. But, again, adults are not like children in this regard.

However, quite a bit of angulation can be accepted in healed humerus fractures, because of the mobility of the shoulder. As opposed to the forearm bones (radius, ulna) and the bones of the lower extremities, which have to basically put back as close to anatomical as possible, humerus fractures can have some residual angulation, without the patient having too many problems.

The criteria for an acceptable reduction in humeral shaft fractures are generally given as the following:

** Less than 20 degrees of anterior angulation
** Less than 30 degrees of varus/valgus angulation
** Less than 3 cm of shortening

Again, this amount of angulation is acceptable because of the great shoulder mobility. The movement in the shoulder makes up for the residual angulation.



You still have a long ways to go, in terms of your final recovery. Recovery does not “just happen”, it takes a lot of hard work and time in the gym, in therapy. Again, it usually takes about 6-8 weeks for a humerus fracture to unite, then you get to start the hard work of recovery.


Your treatment up to this point has been the usual method. Most of the time, the patient is placed in a cast or splint for the first 7-10 days (most commonly by the ER or the orthopedic surgeon on call). Following this, the patient is then usually placed in a “clam shell”, or co-apt (coaptation), splint. This is a type of functional brace, frequently used in midshaft humerus fractures. The functional brace is mainly just for patient comfort. It essentially uses the “soft tissue envelope” around the fracture in the upper arm, to stabilize the fracture somewhat. Again, this is mainly just for patient comfort.

In some cases, the fracture just does not heal. If this were to occur, then surgery to bone graft the fracture is usually recommended. Also, some fracture patterns are known to frequently go on to a nonunion, and as such, these fractures are usually treated early on with ORIF (open reduction and internal fixation). But, because of the risks associated with surgery (specifically injury to the radial nerve), it is not the usual first line treatment method.


Wishing you the best. Good luck.
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replied June 30th, 2013
hello everyone,

i had a mid humerus fracture in a motorcycle accident last june 16, after 2 weeks my doctor replace the cast with a functional carbon fibre type cast after which i had an xray done but what bothers me most is there is a gap of about 1cm on the fractures end.

the swelling on back of my arm has subsided a bit but is still visible on my wrist and forearm up to the elbow.

will they ever come together or do i need some kind of contraption that would make the gap closer. my next appointment will be on july 16 and i will have to get another xray prior to it....what if the gap is still there? should i still be on a sling?
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replied June 30th, 2013
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kitz54,

If there truly is a gap of a centimenter, no the bone will not heal. The osteocytes (bone cells) cannot "jump" that big of a gap. The ends of the fragments should be touching, for the bone to heal.

Sometimes, just the weight of the forearm will pull on a humerus fracture, producing a gap. If this is the cause, the cast should be removed and the patient placed into a co-apt splint (also called a clam shell) and use a sling to support the weight of the forearm and hand.

But, if the gap is due to some soft tissue interposed between the fragments, then surgery would have to be done to remove the soft tissue.


So, you should probably discuss the situation with your orthopedic surgeon.

Good luck.
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replied June 30th, 2013
initially, when i was brought to the er and had a couple of xray's i was put on a clam shell type plaster cast supported with a sling. the cast was heavy, hot and discomfortingly itchy. i was also told that they would replace it with a fibreglass functional type cast and that was what they did on my first appointment.

i do believe that the bone will not overgrow the gap and there was no soft tissue interposed between them.

what i wanna know is if the gap would close by itself, not by bone overgrowth but because of exercise as i try to use my fingers, wrist, elbow and arm muscle. what i am saying is if the arm muscle is pulled, will they contract back to its original place so that the fractures come end to end without surgery.
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replied July 1st, 2013
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kitz54,

No, the bone will not fill in the gap. The bone needs to be touching or within a couple of millimeters of touching, for union to occur.

What you had placed initially is often called an "elephant ear" splint. This is the most common way of initial immobilization. Then, usually, after a week or so, when there is some osteoid formation around the fracture to make it "sticky", the plaster splint is changed to a co-apt (clam-shell) splint. This is a plastic splint which only goes around the upper arm, and is held on with Velcro straps. It uses the compression of the soft tissues to hold the fragments in general alignment.


But, again, if you have a gap of a centimeter, the callus will not fill in the space (bridge the gap). You need to discuss the situation with the surgeon.

Good luck.
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replied July 3rd, 2013
Gaelic,

i live in a third world country and the orthopaedic hospital where i was brought to was a very busy government run hospital.

i was not able get an appointment with my doctor but was referred to another resident surgeon for advice on my predicament. i was told that the functional fiber glass type cast was used so that i could do muscle exercises on my wrist, forearm, elbows and upper arm muscle...i was told that every time i use them, my arm muscle contracts and in turn or in time would move or make the fractures come "nearer" to each other until both fractures come end to end for a posible union.

but i still put my trust on a coaptation splint rather than hope that muscle exercise and contraction will do the job.

my next appointment with my surgeon is on july 16, and if xray would still show the 1 cm gap i would ask for a coaptation splint.
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replied July 3rd, 2013
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kitz54,

If the fiberglass cast is just around the upper arm, it sort of works like a co-aptation (co-apt) splint. But, since it is a cast, you cannot schinc it up (snug it up) as you lose muscle mass or the swelling goes down. With the co-apt splint, you can make the splint fit tightly around the upper arm with the Velcro straps. If needed, you can actually order clam shell splints off the internet. They are also called fracture braces or a Sarmiento brace.



Some humerus fractures are treated with a "hanging arm cast", which is designed to act as a weight, pulling down on the arm, to better align the fracture (sort of a mobile traction unit). But, an x-ray has to be taken a couple of days after this type of cast is applied, because if there is distraction at the fracture site (a gap), it has to be discontinued (distraction of the fracture prevents it healing).


In some patients, with continued muscle contraction, the gap will close down. But, again, if there is not closed, with some callus formation, at your next visit, something needs to be done.

The concern when a gap persists, is that there is some soft tissue interposed between the fragments. Some times, when a fracture occurs, the bones move apart and a bit of muscle or fascia gets in between them, preventing the bones from touching again. If this has occurred, usually surgery is necessary to remove the soft tissue.

Sometimes, with the use of real time fluoroscopy (real time x-rays, also called a C-arm), the surgeon can have the patient contract the muscles around the upper arm, to see if the bones come into contact. If the gap still persists, there is usually soft tissue in the way.


Wishing you the best. Good luck.
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replied July 4th, 2013
Gaelic,

yes the swelling has gone down and the cast is now somehow loosely fit, my surgeon must have anticipated this that's why the inner lining of the cast, or the "stockings" is out at the upper portion of the cast and swung around my other armpit to snugly pull it up.

I could still hear occational clicking sound which would mean the fractures are not yet joined together.

if there are soft tissue interposed between the fractures would they hurt?....I feel no pain at all, only occational discomfort.

I will have to be patient and wait it out until my next appointment and just hope for the best.


btw pls. disregard my message vas the problem lies with my browser google, changed to yahoo and it worked fine.


kind regards,

kitz54
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replied July 4th, 2013
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kitz54,

The clicking is usually because the fracture is moving a little. That is actually a good thing, because it means that the ends of the bone are coming together.

So, there may not be any soft tissue interposed. Again, a good thing.


Hang in there. Let us know how things go at your next appoint.

Good luck.
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replied July 19th, 2013
Gaelic,


bad news, good news. the gap was still there, but now the size was cut in half. thanks to my arm exercises.
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replied July 7th, 2013
Hi, I'm a 45 yr old woman, non-smoker, living in UK. I sustained a transverse mid-shaft humerus fracture of the left arm 8 weeks ago. My last X-ray was 3 weeks ago and although the bones aren't perfectly aligned the consultant was happy enough that there was 'sticky stuff' forming and my brace was removed, and I was told to carry on as normally as possible but to avoid lifting anything. I was given a foam sling to use when out and about. So far I have not had any formal physio and have been doing as I was told and trying to carry on as normal. I returned to my office job after 3 weeks and am now able to type on a keyboard with both hands - words per minute with one hand got quite good! I am still experiencing an ache around the fracture site and around my elbow - it feels as if a nerve gets trapped sometimes - is this normal? Also, my consultant said that I would be able to drive again by now but I have absolutely no strength in my arm for forward motion and simply cannot move my gear stick at all - again, is this normal and how long will it be before I can drive?

I have read all posts with interest, especially about raising my arm without support. Yesterday I managed with some difficulty and pain to raise my left arm to peg washing on the line - after reading your advise Gaelic I suspect I should not have done this and wont be doing it again for a while!
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replied July 7th, 2013
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SharonWB67,

Sounds like you are pretty much on course for a humerus fracture.

In humerus fractures, the alignment does not need to be absolutely straight. In fact, up to about 20 degrees of angulation can be accepted, due to the great range of motion in the shoulder.


It is usually not recommended that patients with midshaft humerus fractures do any unsupported lifting of the arm, due to the bending moment it puts on the fracture site. Wall walks, in which the patient put the fingers on a wall, and then "walks" up using the fingers. Pulleys can be used to help get range of motion of the shoulder. There is also some more advanced activities using a walking stick or cane, in which the good hand moves the stick and thereby moves the injured limb.


As to driving, that is a very personal thing. You should not drive until you feel safe behind the wheel. You may want to go out in the country, with another driver, to practice before actually going out on your own. You probably will not be able to drive until you regain some of your muscle mass and strength.


You have lost a lot of muscle mass from being immobilized. So, you are going to be very week. You have to rebuild all of this muscle mass. But, that has to wait until the fracture is completely healed.

Remember that when a fracture occurs, it is not just the bone that is injured. All of the soft tissue around the fracture is also damaged. The soft tissue will heal, but it heals with scar tissue.

Sometimes, the radial nerve can be entrapped in the scar tissue and healing bone of the fracture. If this happens, weakness in the muscles innervated by the radial nerve may occur (muscles to extend the wrist and fingers). Sensation in the radial nerve distribution may be altered (lateral forearm and back of hand).


Most likely, you have not been moving the elbow very much. Stiffness and soreness set in pretty quickly. So, you may want to be sure to do range of motion exercises for the fingers, wrist, and elbow at least a couple times a day. You can also do pendulum exercises for the shoulder.


Wishing you the best.

Good luck.
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replied July 9th, 2013
Gaelic,

Thank you for your swift response and the reassurance. I have started doing the 'walking fingers up the wall' exercise that you suggested in previous posts and that seems to be helping. I guess I will have to be patient regarding the driving until I get my strength back - it would good to hear from my fellow break sufferers as to how long it was before they could drive so I can gauge timelines.....I have read on other sites that there are exercises that can be done rolling a tennis ball across a flat surface backwards and forwards - is this a good one to try?
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replied July 19th, 2013
Gaelic,


bad news, good news....the gap was still there, but! it was half its former size, thanks to my arm exercises.

we discussed the 1cm gap and she shrugged it off that the xray plates that i was looking at was magnified. she told me that spherical fractures is best because it has 3 bonding sides. that it was like a tall letter "Z". the gap is wider on the upper part about 2-3mm because the fractures were not aligned perfectly, but the vertical fractures is just 1cm apart likewise with the lower part of the fracture.


my surgeon was optimistic that there would be a union as my latest xray shows signs of callous formation, i'm just 1 month into my accident.


kind regards,

kitz54
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replied August 25th, 2013
I fractured my humerus (anatomical neck of humerus)3 weeks ago,and slowly recovering,still some swelling present upper arm,near elbow and fingers.rather worried when I take my arm out of the sling and on straightening it,i flex fingers out that's when i get pain underneath middle finger,also feels slightly stiff. only painful when arm is straight.could this just be due to lack of circulation or should I be concerned it might be nerve damage?i have good range of movement with wrist and fingers and work them a lot.thanks,finding all previous posts helpful!
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replied September 15th, 2013
Gaelic,

I am a 22 year old female who unfortunately fractured her proximal humerus after falling from a height. the bone is broken in only one place near the top of the bone, and is only minimally displaced, so my doctor ruled out surgery and said that about 4 weeks in a collar and cuff should do for the realignment of the fragments, and that at 2 weeks I should even start seeing some increased motion. Of course, it will take diligent physio after this to have my arm return even close to "normal." I'm just wondering if you think my age will aid me in the healing process, and if this sounds doable? Also, if you could give me some tips on when and what I should be doing to start rebuilding motion and strength. At present, I am a student and know it will be hard to function on pain medication and without being able to properly dress / shower / move around, so any tips would be greatly appreciated!

-Justine
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