Midshaft displaced spinal fracture of left humerus

Highgate,

I answered you other post also. I copied it below just in case one of these gets deleted (since they are very close to being the some, the Admin sometimes deletes one).

If you can stop smoking, at least till the fractre is healed, that would probably be the best thing you could do to get this bone to heal. Even one cigarette causes significant decrease in the blood supply to the healing fracture. Sorry, but nicotine is very vasoconstricting. The new bone is filled with tiny blood vessels, which get cut off each time you have a cigarette. Again, if you could just stop till the bone has united, that would be the one best thing you can do.

Other information is in the other message:

highgate,

It usually takes around 8-10 weeks for a humerus fracture to unite, but everyone is different.

If you have minimal pain and no gross motion at the fracture site, those are good signs. The body will lay down osteoid first around the fracture site. This will make the fracture "sticky". Then the body will calcify the osteoid to make it callus (new bone formation). So, you are probably healing the fracture, since you were transitioned to the fracture brace.


As to regaining range of motion and strength, it will come, but you have to work at it. Again, everyone does it at his/her own rate. And, you actually have to work on it, it won't just happen on its own.


As to fracture healing, make sure you eat extra protein. Also calcium and vitamin D are necessary. Do not smoke. Limit alcohol consumption.


So, it is not actually possible to give you a date when you will be able to return, since several things have to happen (bone union, range of motion, strength). Once union of the bone has been achieved, then the harder you work at rehab, the sooner you will be able to return (usually).

In the meantime, work on wrist, elbow, and shoulder motion. If you can get some TheraPutty, it is great for regaining forearm and grip strength. Hand gripper are okay also, as long as you can completely close the fist.


Good luck. Hope you heal soon and get back to your regular activity.

Gaelic,
Thanks for the response. As to the not smoking I know it makes sense I'm just finding it very difficult during this time.

I already took high strength Gloucasmine & Cod liver oil as I've previously lost most of the cartilege in my left knee during 2 ops for tears, but have added calcium with vitamin D & Magnesium supplements as well as increasing my intake of Protein by eating more dairy (cheese/milk etc). Don't really drink anyway and have not had any since accident, so if I could just get past the nicotine addiction feel I would be on the right track.

I've been exercising my hand since swelling receded by making fists & stretching hand fully out, whats Theraputty ?, since getting brace I have only done a little elbow exercising, small lifts of the shoulder as the fact that the consultant vetoed referring me to physio until after my next visit has made me somewhat cautious.

I am presuming that still feeling clicking sensation at sight of break is to be expected and that I am not actually causing damage.

I know from my experience with cartilege tears that you only get out of physio what you put into it, I'm just really worried by the amount of people who seem to have followed the same course of treatment as I have only to find that non-union still made them candidates for surgery. I really dont want that complication as I know that it is not always the magic wand people think it is.

Thanks for the words of wisdom, I'm off to tear up my remaining cigarettes now (just hope I can then subsequently be strong enough to stop me getting some more, but then they dont call it an addiction for nothing).

highgate,

I know it is very, very difficult to quit smoking. Though not ideal, there has been some research that states that the nicotine gum is actually less "damaging" than smoking. Again, not ideal, but a little better. You might look into that.

The clicking is very common. It means the fracture still has not healed and is moving ever so slightly. Since it does not hurt a lot, that is a very good sign. The body has laid down some osteoid to make the bones "sticky", to glue them together. The body then comes in and calcifies the osteoid to make callus, the new bone formation.


Yes, as long as you have the clicking, shoulder motion may have to be delayed. As soon as you are allowed, start doing the pendulum exercises (Codman's). Some surgeons will even allow these will the patient is in a sling, but others are more conservative. So, always follow your surgeon's instructions.

The shoulder can get really stiff, so again, as soon as you are allowed, jump on the range of motion. You do not want to get a frozen shoulder.


With the elbow motion, one trick, is to hold your upper arm against your chest wall with your other hand. This will stabilize your fracture (keep brace on of course) while you are moving the elbow up and down. Remember to work on pronosupination (turning the palm up and down). You will sometimes notice the muscles in your upper arm contracting when you turn your palm up (supination). The biceps muscle is actually responsible for that motion.



TheraPutty is a putty like substance that occupational/hand therapists have their patients use to regain finger motion and forearm muscle strength. It comes in various firmnesses (which are color coded), from very, very soft with little resistance to very, very firm, almost like taffy.

It is used by just squeezing it. It allows full finger range of motion while strengthening the muscles in the forearm. As you get stronger, you change colors of TheraPutty, going to firmer and firmer ones.

You can ask your therapist about it. Many of them have tubs of it in their clinics. He/she should be able to get you some. Just do not drop it in the carpet, it is not play-dough, and it is tough to get it out of shag carpet (so I have heard).



So, again, if you can stop smoking, at least till the bone heals, that is the one best thing to do. The protein, calcium, vitamin D, magnesium, and other supplements are great. Work on finger, wrist, and elbow range of motion. You can use the putty to get grip strength. You can use light weights for wrist curls and rotations.

The more the distal joints/muscles have been worked toward being "normal", that is just that much less you have to worry about later.


Hang in there. You know from your previous injuries, this will take some work. Good luck.

Hi Gaelic

Thanks for all your advice, it is extremely reassuring to hear someone elses views on my progress etc., I can see from your profile that you are somewhat of a bsckbone to many users of this forum, are you involved in the health profession or have your own misfortunes & experiences given you your knowledge.

highgate,

Unfortunately, it is both professional and personal experience.


On the elbow motion, you know it will take time, but sometimes, if you eliminate gravity it is easier to regain the active motion. So, some patients will do the elbow active range of motion while lying down.

Again, holding the upper arm against the chest wall with the other hand, place forearm on the abdomen, and just rub your belly. Get the elbow as straight as you can, then bring it up towards your chin as much as you can. By doing the exercises this way, the weight of the arm due to gravity is eliminated.

As always, if it is hurting at the fracture site, back off a little. Muscle soreness from working out is okay, but it should not hurt sharply or intensively, directly at the fracture site.

Once you have the range of motion pretty well under control, then you can transition to doing the exercise standing up. The weight of the arm acts as a "weight" at first. When this is easy, then you can add very light weights (eg a can of soup).

Elbow motion can be a problem at first, because the muscles that move the elbow are located in the upper arm and attach to the humerus. So, the muscles can pull on the fracture.


And, you are correct, that surgery is not a magic wand. Unfortunately, there are no magic pills or magic wands in medicine (though I once heard a patient call the MRI the magic resounding imager). Surgery should only be done when it is necessary to achieve the results needed.

Sometimes, patients will have surgery for some shaky reasons. A patient once wanted to have surgery on her ankle so she would not be in a cast and have an uneven tan line. Yea, an uneven tan line on her leg. Go figure.

But, when needed, it is nice that surgery is much safer than it was just a few decades ago. Heavens, in the first half of the twentieth century, it was almost a death sentence. Before antibiotics and proper general anesthesia, it was a major undertaking. However, it is still risky. General anesthesia is usually of most concern to the surgeons, and as such, usually prefer patients to have regional blocks done.

But, I digress.


Good luck. If you can quit smoking, that would be awesome. If you ever needed a good reason to quit, avoiding surgery for a nonunion would be a very good one. Hang in there.

Hi Gaelic,

Thought that your knowledge base was grounded in involvement in the health profession and as to your personal experiences hope that all this is past tense.

Thanks for asdvice on ROM and tips regarding discernment between fracture & muscle pain, when the consultant physically tested the fracture site upon removal of cast, whilst there was obviosly pain from the fracture site a lot of it was from the shoulder, whether this was due to muscle wastage/lack of use or because of the fracture along the bone into the proximal head I do not know.

Since using the brace I can straigthen my arm, hanging down about 80% and lift it up to my chest with very little discomfort & generally no pain from fracture sight, no clicking either as long as I keep arm moving close to my body. The only shoulder movement I have done is, keeping arm close to body, lighting shoulder and doing rolling motions up & down. I can go without sling but if moving about quite a bit then prefer to return to its comfort.

Again thanks for all your advice it is most appreciated.

When I first did this I was on nicotine patches but then concluded that this was probably worse then having the odd cigarette as these provide a constant supply of nicotine to the blood supply and stopping using them did seem to coincide with what felt like more recovery, whether this was true or just because the initial signs of trauma (swelling) was reducing I dont know.

Had new X-ray 5 days ago and whilst the fractures going up towards proximal head & smaller one going down the bone look like they are healing, there is very little sign of healing or re-alignment of main break. Still in humeral brace & still experiencing clicking but despite poor X-ray I can lift my arm (out of brace) so that elbow is nearly as high as shoulder with no clicking but obviously with discomfort so I am hoping that something good is going on. Consultant wants to re Xray in another 4 weeks and if still not very good do a CT Scan begore making decision as to whether we now need to look at a Op.
Obviously I am very disappointed at this as I've been quite diligent at not doing anything which is bad, including smoking which is still driving me absolutely crazy going cold turkey and doing all the supplements with as balanced a diet and increased protein. I've gained 6 LBs which is no small amount as I'm only 4' 10", cant get in many of my clothes and the mild sciatica I've had for years & kept at bay by keeping my weight down is increasing daily.
I have had to return to work which is only possible due to the help of a colleague driving me as my company will only make my pay up for 6 months in any 12 month period so if it does turn out that I need an Op I need to keep my remaining 3 months to cover Op & its associated recovery.
I did query with my consultant about the possibility of Ultrasound therapy as I'd found on the net that this was supposed to be an aid in speeding up bone recovery but this is not offered on NHS, at least not at my local Hospital but then when I contacted a Physio was told that this is not a proven aid, does anyone have any personal experience on this or any other advice that might help me speed things up.

Had new X-ray 5 days ago and whilst the fractures going up towards proximal head & smaller one going down the bone look like they are healing, there is very little sign of healing or re-alignment of main break. Still in humeral brace & still experiencing clicking but despite poor X-ray I can lift my arm (out of brace) so that elbow is nearly as high as shoulder with no clicking but obviously with discomfort so I am hoping that something good is going on. Consultant wants to re Xray in another 4 weeks and if still not very good do a CT Scan begore making decision as to whether we now need to look at a Op.
Obviously I am very disappointed at this as I've been quite diligent at not doing anything which is bad, including smoking which is still driving me absolutely crazy going cold turkey and doing all the supplements with as balanced a diet and increased protein. I've gained 6 LBs which is no small amount as I'm only 4' 10", cant get in many of my clothes and the mild sciatica I've had for years & kept at bay by keeping my weight down is increasing daily.
I have had to return to work which is only possible due to the help of a colleague driving me as my company will only make my pay up for 6 months in any 12 month period so if it does turn out that I need an Op I need to keep my remaining 3 months to cover Op & its associated recovery.
I did query with my consultant about the possibility of Ultrasound therapy as I'd found on the net that this was supposed to be an aid in speeding up bone recovery but this is not offered on NHS, at least not at my local Hospital but then when I contacted a Physio was told that this is not a proven aid, does anyone have any personal experience on this or any other advice that might help me speed things up.

Well saw CT scan result today and things not looking good on main break, very little sign of healing. Have to see Consultant in 2 weeks (saw his Registrar today) but it is looking like despite all the attention to supplements & balanced diet, plus mind blowing craving for nicotine have all been to no avail. 4 months down the line and apart from the fractures along the bone healing all I've gained is a stiff elbow & shoulder.
If the consultant is of the same mind as his registrar and I do have to have it plated & pinned (possibly with bone graft) can anyone advise me on what I can expect once I've got over the initial trauma of the operation itself, i.e., how long is the recovery, do you get to start physio asap etc