What is the outlook?
How well a break to the upper arm (fractured humerus) usually heals does depend on things such as which part you have broken, how you broke it, how badly you have broken it and how old you are. Most breaks of the upper arm heal very well and a broken upper arm has usually healed within a month or two.
However, if you are very elderly and have broken your upper arm at the top (proximal humerus fracture), it is unlikely that you will get the full range of movement back in your arm and shoulder but the aim of treatment will be to get the movement good enough for you to be able to do everything that you need to do.
What are the possible complications?
Complications are rare. There are several types of complications that can occur:
When the two ends of the broken bones don't mend, this is called malunion. This is not always as bad as it sounds and may still allow you to use your arm almost normally. It is more common in older people.
There are lots of important nerves and blood vessels that are very close to the bone of the upper arm. These can be injured when the upper arm is broken. This is called a neurovascular injury. Nerves and blood vessels may also be injured during surgery to mend the break. Your health carers will check you regularly after an upper arm break to make sure that there is no sign of any injury to a blood vessel or a nerve.
- About 1 in 3 breaks of the top of the upper arm (proximal humerus fracture) will damage one of the nerves.
- About 2 out of every 10 people who break the middle of their upper arm (humeral shaft fracture) will also damage a nerve called the radial nerve. It is particularly common if the break is in the lower part of the shaft. For 7 out of 10 of the people affected, it recovers completely without any need for surgery.
- The brachial artery can be injured with a humeral shaft fracture but this is rare.
If the blood supply to bone is damaged, that bit of bone dies. This is called avascular necrosis. It can happen if you have broken your upper arm right at the top, affecting the humeral head. Avascular necrosis is more common if the break has created several fragments. If affected, you will develop a painful and stiff shoulder. Eventually you may need to have surgery to replace your shoulder joint.
Associated shoulder dislocation
Dislocating your shoulder at the same time as breaking the top of your upper arm (proximal humerus fracture) is most likely if you are young.
Associated rotator cuff injury
The rotator cuff is a group of four muscles that are positioned around the shoulder joint. It helps to stop the shoulder from dislocating. It can be damaged when you break the top of your upper arm (proximal humerus fracture). Rotator cuff tears usually improve with physiotherapy but surgery may be needed.
Further reading and references
Kim SH, Szabo RM, Marder RA; Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res (Hoboken). 2012 Mar64(3):407-14. doi: 10.1002/acr.21563.
Jordan RW, Modi CS; A review of management options for proximal humeral fractures. Open Orthop J. 2014 Jun 278:148-56. doi: 10.2174/1874325001408010148. eCollection 2014.
Wang Y, Zhuo Q, Tang P, et al; Surgical interventions for treating distal humeral fractures in adults. Cochrane Database Syst Rev. 2013 Jan 311:CD009890. doi: 10.1002/14651858.CD009890.pub2.
Clement ND; Management of Humeral Shaft Fractures Non-Operative Versus Operative. Arch Trauma Res. 2015 Jun 20
Pandya NK, Baldwin KD, Wolfgruber H, et al; Humerus fractures in the pediatric population: an algorithm to identify abuse. J Pediatr Orthop B. 2010 Nov19(6):535-41. doi: 10.1097/BPB.0b013e32833ce424.
Harding P, Rasekaba T, Smirneos L, et al; Early mobilisation for elbow fractures in adults. Cochrane Database Syst Rev. 2011 Jun 15(6):CD008130. doi: 10.1002/14651858.CD008130.pub2.
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