The fracture of the humerus is an important injury characterized by the interruption of bone tissue affecting a long bone, precisely the humerus, which connects the shoulder to the forearm. Fractures of the long bones are divided into three types based on location: the upper part of the arm bone is called the proximal humerus, therefore we speak of proximal fractures; the terminal part of the bone is called the distal humerus, hence the terminology of distal fractures; in the middle there is the diaphysis therefore the fractures are defined as diaphyseal.
Fractures of the humerus can occur by many different mechanisms but are most commonly caused by trauma, whether sports, accidental or secondary to traffic accidents. Also, a humerus fracture sometimes occurs when the bone is weakened by osteoporosis or by cancer, infection, or other metabolic problems. This condition is called a pathological fracture.
Fracture of the proximal humerus
Fractures of the proximal humerus occur near the shoulder joint. These fractures may involve the insertion of the major rotator cuff tendons and/or affect the glenohumeral articular surface.
Diaphyseal fracture of the humerus
They are humerus fractures that occur between the shoulder and elbow joints. A large proportion of these fractures can heal without surgery; the therapeutic, conservative or surgical procedure depends on the characteristics of the fracture itself.
The pre-operative "planning" of these fractures must be scrupulous as noble structures such as arterial and venous vessels and nerves run adjacent to the humerus in this portion of the arm.
Distal humerus fractures
Distal humeral fractures are less common injuries. These occur near the elbow joint, often due to high-energy blunt-sprain trauma and most often require surgical treatment for proper restoration of the joint surfaces.
Most humerus fractures are able to heal without surgery, with a brace that immobilizes the joint for 3 to 4 weeks. With immobilization the fracture will undergo spontaneous healing. It is important to ensure that the humerus axis or articular regions are kept in anatomical position.
Surgical treatment of shoulder fracture
Surgery of the humerus, as already pointed out, may be necessary when the bone fragments are far from their natural position, in which case the fracture is defined as "displaced". Determining whether alignment is acceptable depends on a number of factors. Fractures near the shoulder and elbow joints, especially fractures that extend into the joint, are more likely to require surgery because failure to reconstruct fractures may result in impaired motion with functional limitation of the fractured joint and, over time, to the onset of osteoarthritis.
The type of intervention that is carried out for the fixation of a humeral fracture depends on the physiognomy and characteristics of the fracture itself.
In relation to the degree of decomposition, the number of bone fragments and their size, we will opt for a fixation with angular stability plate and screws (with the possibility of using bone grafts to support the fracture) such as those shown in the following videos.
If the fixation procedure with an angular stability plate and screws is not possible, the joint will be replaced prosthetically.
The operation is always performed "in the open", i.e. with a small skin incision which allows the surgeon to proceed safely avoiding vessels and nerves and which allows to visualize all the fragments of the fracture so as to be able to "reassemble the puzzle" in a as precise as possible (reduction) and thus block the fragments (synthesis).
When the displacement and the "comminution" (the size of the bone fragments) do not allow to obtain a reduction of the fracture, the surgeon can opt for the implantation of a specific prosthesis dedicated to significantly displaced articular fractures.