According to abbreviationfinder, humerus head fracture is short for HHF. The humerus head fracture or humerus head fracture is a fracture (bone fracture) that is particularly common in older people. It manifests itself through severe pain and restricted mobility of the affected arm and is usually caused by falls onto the outstretched arm, which are caught with the hand, so that the shaft of the humerus is driven up through the head. Alternatively, the fracture can be caused by falling directly onto the shoulder, usually only part of the head breaking off.
What is a humeral head fracture?
By definition, a humeral head fracture is a fracture of the head of the humerus, i.e. above the neck. The neck of the humerus is not easy to delineate, so a humeral head fracture is commonly referred to when the humerus is broken above the shaft.
It must be differentiated from a humerus shaft fracture or a distal humerus fracture, i.e. a humerus fracture at the elbow joint. A so-called subcapital humeral fracture occurs when the shaft breaks at its transition to the humeral head and the shaft is only slightly pushed into the humeral head.
Causes
The main causes of humeral head fractures are falls in which patients try to catch themselves with an outstretched arm, or falls directly onto the shoulder. It mainly affects older people who already suffer from osteoporosis.
With severe osteoporosis, a strong blow to the shoulder is enough and the humeral head breaks. This hit can come either from the side or from above. The shoulder joint is the most unstable joint in the entire body, with a 4:1 ratio between the head and socket. The joint is only stabilized by the muscular rotator cuff (several muscles give off fibers that almost completely surround the joint).
However, the rotator cuff cannot protect against fractures, which is why dislocations (“dislocated” joints) and fractures are common here. However, the fracture can also occur in young people after major trauma, such as skiing accidents or falls on the shoulder from a great height.
Symptoms, Ailments & Signs
In the case of a humeral head fracture, there is typically a painful restriction of movement in the shoulder area. A swelling develops in the area of the humeral head and above that hurts when touched. This pressure pain is usually accompanied by sensory disturbances or signs of paralysis.
Bruising may occur in the armpit area, which may extend to the inside of the arm and the side of the chest. Affected people often move the arm in a relieving position due to the pain and support it with the other arm. If the humeral head fracture involves dislocation of the humeral head from the shoulder socket, it can be clearly palpated under the skin.
A simple humeral head fracture cannot be recognized externally. However, the symptoms can usually be traced back to a specific cause. Assuming early treatment, the symptoms subside after four to six weeks. The movement restrictions can last up to two months.
Permanent restrictions may remain. Chronic pain can set in or mobility is permanently reduced as a result of a humeral head that has not grown together optimally. If the head of the humerus is broken into many fragments, the symptoms mentioned can be very intense. Bone splinters may detach and cause tissue damage.
Diagnosis & History
The diagnosis is relatively easy to make. The patient comes to the doctor with pain in the shoulder. The first step after the physical examination is an X-ray examination, on which the fracture can usually already be seen.
Computer tomography is then used to determine more precisely how the individual fragments of the bone are positioned. The progression of a humeral head fracture is usually good because the therapy, especially if a prosthesis is used, can restore full mobility of the arm.
Complications
Complications can occur as a humeral head fracture progresses. It is not uncommon for various injuries or impairments to the nerves or vessels that are located in the shoulder area to appear as a direct consequence. As a result, the people affected suffer from symptoms of paralysis or circulatory disorders.
In some cases, partial stiffening of the shoulder joint occurs with both conservative and surgical therapy. This complication can usually be treated by arthroscopic capsule splitting, which is combined with anesthetic mobilization and regular physiotherapeutic measures.
In some patients, the humeral head fracture does not heal properly. As a result, there is a risk of a so-called pseudarthrosis, also known as a false joint. Pseudarthrosis is when the broken bone fragments do not grow back together properly into a joint.
Other conceivable complications are a renewed misalignment of the fracture, death of the humeral head, which particularly affects older patients, a labrum lesion, which is an injury to the joint lip, and a rotator cuff tear. The rotator cuff is a four-headed muscle group that plays an important role in shoulder movement.
If there is a severe humeral head fracture, there is a risk of injury to the axillary artery or nerves. It is also possible for infections to occur at the surgical site after surgery for a humeral head fracture. This complication is particularly feared by doctors because it makes further treatment significantly more difficult.
When should you go to the doctor?
Elderly people who experience severe shoulder pain after an accident or fall should consult their family doctor. A humeral head fracture is usually easily treatable, but requires rapid clarification by a doctor. That’s why you should see a doctor as soon as possible if you have unusual problems in the shoulder area. This is especially true when symptoms are rapidly increasing in intensity. If bruising, swelling or increasing mobility restrictions occur, a doctor must be consulted on the same day.
In the event of signs of paralysis or circulatory disorders, it is best to go to the doctor’s office or the nearest hospital immediately. People who suffer from severe osteoporosis are particularly at risk. The fracture occurs primarily in older people who have previously fractured the shoulder bones. If you belong to one of these risk groups, you should speak to your family doctor or an orthopaedist if you experience sudden pain. If signs of pseudoarthrosis appear after treatment of a humeral head fracture, the doctor responsible must be informed.
Treatment & Therapy
Then the operation is planned, sometimes using screws and wires and sometimes replacing the entire head of the humerus (especially in patients with osteoporosis and arthrosis ) and using a so-called total endoprosthesis (TEP).
When it comes to treating a fracture, there are many surgical options, the selection of which depends on which parts of the humeral head are fractured and how stable or unstable the patient’s bone substance is. Surgery is always performed on humeral head fractures because, unlike rib fractures, this fracture does not heal properly on its own. Also, the shoulder is just too important a joint to leave correct healing to chance.
After the operation, the patient is usually given a special bandage that fixes the arm in a certain position: bent at right angles in the elbow joint, anteverted by about 30 degrees, i.e. rotated forward. If the arm is fixed close to the body, as was customary in the past, there is a risk of a nerve being trapped. This can lead to chronic complaints – that’s why there are now special prefabricated positioning cushions that are given to patients in a standardized way for such operations.
It is important that the patient leaves his arm alone but does not work too little with it; physiotherapy is usually prescribed. The physiotherapists then ensure that the patient moves his arm at least every two days in such a way that healing is not jeopardized.
Outlook & Forecast
The prognosis of a humeral head fracture depends on the severity of the damage and the age of the patient. With increasing age, full recovery is usually no longer possible. The bones become more unstable over the course of life and can no longer be adequately regenerated by the organism in the event of damage. In a large number of cases, elderly patients experience a permanent impairment of mobility and a decrease in general resilience.
In most cases, young patients have a much better prognosis. Complete healing is often documented for them. At the same time, in addition to the age, the number of fragments is decisive for the prognosis. The fewer fragments there are, the better the chance of healing. The best results are achieved with early diagnosis and prompt treatment.
Surgery is part of the treatment plan for all patients. This is generally associated with possible complications and risks. Patients with a weakened immune system show a delay in the healing process. If there are other underlying diseases of the skeletal system, the prognosis worsens even further. Nevertheless, there is no danger to life for the patient with a humeral head fracture. In the worst case, mobility is restricted, which triggers a restructuring of everyday processes. This can lead to psychological complications in individual cases.
Prevention
A humeral head fracture is difficult to avoid because nobody falls on their shoulder voluntarily. However, older people in particular can prevent osteoporosis and the resulting increased brittleness of bones by moving around a lot and making sure they get enough calcium. Calcium is particularly rich in milk and milk products.
Aftercare
Follow-up care depends on whether the therapy was carried out by means of an operation or, as in most cases, by immobilization of the fragments with an orthosis. Postoperatively, follow-up examinations for wound control must be observed, during which the doctor develops an individual therapy plan to achieve normal mobility.
If the affected person has been provided with an orthosis, he may and should use his hand and fingers, but not lift objects that weigh more than a full cup or a telephone receiver. In order to prevent the elbow joint from stiffening, the orthosis must also be removed several times a day and the elbow moved carefully. After three to six weeks, cautious arm movements can be started. If the patient is unsure about this, he can seek support from a physiotherapist.
A check-up after about six weeks decides whether the orthosis has to be worn further or whether it can be removed. In children, with their faster wound healing, this examination can be carried out after 4 weeks.
Muscle strength recovered after 3 months. Nevertheless, sports activities should only be started four to six months after the start of therapy. Pain and swelling can still occur at any time during the first year and is nothing to worry about.
You can do that yourself
After the medical treatment of the humeral head fracture, the patient first immobilizes the affected arm and avoids any strain on the injured shoulder if possible. In this way, it prevents possible complications and promotes the healing process of the fracture and, in the case of a surgical intervention, wound healing. During the initial healing phase, all physical stress should be avoided. Sport should be avoided for the time being, as the risk of injury is too high and shoulder strain is likely. In the case of difficult but necessary movements, the support of another person is recommended.
In the further course of healing, physiotherapeutic exercises promote the restoration of resilience and mobility of the affected shoulder. The patient first practices physiotherapy with a physiotherapist and then carries it out regularly at home in order to quickly rebuild the muscles.
Later, in consultation with the doctor, pain-relieving ointments can be applied externally to the shoulder area, for example with a cooling or warming effect. If there is a scar, the patient relieves unpleasant symptoms such as pain or pulling in the scar area by means of adequate scar care. Gradually, under medical supervision and guidance, the patient increases his physical activity again, which has a positive impact on the general quality of life.
