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upper arm

Fractures of the upper arm….

A broken shoulder, aka a fractured humerus

Fractures of the upper arm, the humerus, are common.  They typically occur after a fall on the arm or shoulder.  These are among the most forgiving fractures in the body. It is often said that if the ends of the broken humerus are in the same room, it will heal.  Because the upper growth plate of the humerus accounts for 70% of the overall growth of the upper arm, this bone has a remarkable capacity for healing and remodeling.  The diagnosis can be subtle at times.  In very young children and infants, they will simply refuse to use the arm.  In older kids, pain and/or deformity are common.  The diagnosis is confirmed by taking an x-ray.

proximal humerus fracture
an AP xray of a fractured humerus– notice how the “ice cream” has slipped off the top of the “ice cream cone”

This is an x-ray of a proximal humerus fracture. The ball that is at the top of the arm bone has been broken and has slipped slightly. This can be compared to an ice cream falling off the top of a cone. Although this fracture looks bad, the body has a remarkable ability to remodel, and this fracture will heal well with very little loss of function, range of motion, or strength.

Treatment of this fracture in children is simple.  Usually, all that is requires is a sling and a swath for comfort.  This bone has a remarkable ability to heal and remodel over a very short period of time.  Parents will often find it disturbing to see the alignment of the look so bad on the initial x-ray and wonder why the surgeon is not recommending an operation.  There are several reasons for this.  First, healing is virtually certain.  Second, the bone will remodel completely in almost every case to the point that you can’t tell that there ever was a fracture after a few years.  Third, because the shoulder is such a mobile joint, minor misalignment is hard to see and does not make a difference in how the arm works.

Several studies have shown that the worst outcomes for this fracture were when surgery was done to improve the alignment!  Only if the bone is sticking through the skin or entrapped in the muscle would we recommend surgery for this fracture.

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3 comments

  1. natasha says:

    my sons arm looks identical to the proximal humerus fracture. The fallin’ “icecream cone” but it is thru the growth plate, and doesnt seem to let gravity help it out…. Dr’s are discussing surgery b/c it is thru the growth plate.. it still looks horrible. his anterior delt looks like its coming thru the front of his body… any suggestion or thoughts?

    1. admin says:

      natasha,
      you can email your xrays to carbon12contact@gmail.com and I will post them with your questions
      admin

    2. paola says:

      natasha,
      my daughter was treated probably the same way in the UK: I would have accepoted it weren’t for some cclose relatives of mine being orthopedists in continental Europe and saying that this would have caused major problems and deformities. We decided to leave as early as possible for a second surgery. the bone needed to be broken again and aligned PROPERLY, and not following the good luck and the gods’ fates of the NHS, with Kirschner wires. She is now doing rehabilitation and moving quite well, although not yet perfectly (she removed the wires on 10/8). Recovery times after the surgery in the UK: 18 months. Recovery times after the EU state nbational health service: 3 months. If I were you I would consider going abroad. All the best to your son.

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