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Broken Humerus help!- Not healing

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hi. i have a mid-shaft fracture in my non dominant arm. happened 6 weeks ago when i slipped on uneven pavement and fell.
was in sling for 10 days then in clam shell like brace for the rest of the 6 weeks.
was told no surgery needed. now at 6 weeks there are no (or very little) signs of heling. i did not see and do not have access to the x rays.
should i be concerned? is this a very bad sign that i won't heal?
i am nervous. ROM getting better in hand/wrist/fingers.
Can do shoulder rolls but not lift arm up without help of other arm.
Please give me any info you have. i know every person is different, but i am losing hope
41 year old woman, non smoker, not very overweight- maybe 10 lbs, not very athletic, former heavy drinker but not drinking often these days- a glass of wine here or there. please let me know about any similar experiences, etc.
going to city clinic and seeing diff doctors each time, residents, etc. not getting a lot of info
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replied February 1st, 2012
Especially eHealthy

By six weeks, there should be at least some callus formation to be seen on x-ray. It usually takes about 6 to 10 weeks for a midshaft humerus fracture to unite. And as you stated, everyone is different.

The fact that you have less pain at the fracture site is a good sign. You do not say if the surgeon checked for gross motion at the fracture site, the last time you had an appointment. Sometimes, a patient will have abundant osteiod around the fracture, which will keep the fracture from moving a whole lot, but since osteoid has not calcified, it will not show up on x-ray. In that case, the fracture is actually healing, it just needs to calcify the osteoid, and then remodel the callus.

However, if these is still a lot of gross motion at the fracture site, then that usually means the body is not laying down the needed materials to heal the fracture.

There are a few different ways you could go from here. One is to continue with the co-apt splinting for a few more weeks, to see if the body gets its act together and starts to heal the bone.

You could try a bone stimulator. This is a device which has a coil that is placed on the skin over the fracture. Then, with either electromagnetic pulses or ultrasound fields, the bone is stimulated to heal. Some surgeons think they are very good adjuncts to fractures with delayed healing, while others don't think much of them. But, they are covered by most insurance companies. You might discuss the use of one with your surgeon.

Though it is still just a little early to jump to surgery, if there is no sign of healing in the next few weeks, that is probably in the future. If the bone does not show signs of laying down callus, then the fracture will probably have to have an ORIF (open reduction and internal fixation). The usual method is to place a plate and screws across the fracture, after the fibrous material within the fracture has been removed, and then the fracture site is bone grafted. The bone graft brings in osteogenic cells and scaffolding, to help jump start the healing process.

The fact that you do not smoke is great. Hopefully, you are still the occasional wine drinker. Heavy alcohol use can affect bone metabolism. You should eat a well balanced diet, with some extra protein, calcium, and vitamin D.

Continue to work on the finger, wrist, and elbow active motion. You should be able to do the shoulder Codman's (or pendulum) exercises. These are basically leaning over with the good hand on a low table, then having the injured arm swing back and forth, side to side, and around in circles. These can even be done with the arm in a sling, but is usually better for the elbow if they can be done out of the sling.

But, you need to avoid placing any bending moments on the humerus. Such as lifting the hand straight out in front or to the side. The weight of the hand and forearm is too much to place across an unhealed humerus fracture.

So, the surgeon may want to wait a few more weeks, just to see if the fracture will get its act together, but if there is no signs of healing by then, you are probably looking at having surgery.

You can discuss your treatment plan with your surgeon. You might ask about the bone stimulator.

Hang in there, you have come this far.

Good luck.
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