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The primary goal of the clinical evaluation of a humeral shaft fracture is to decide how the fracture can be treated - with or without surgery - and to evaluate whether there has been damage to the radial nerve.
There are several factors that determine whether your surgeon will suggest treating the fracture with or without surgery. Surgical treatment of humeral shaft fractures can be performed in three ways: an intramedullary rod (a metal rod inside the bone), a metal plate and screws along the side of the bone, or an external fixator with metal pins through the skin. Open Reduction and Internal Fixation (ORIF) of humeral shaft fractures using a metal plate and screws is also very common. Rehabilitation will begin once your surgeon feels that the fracture is stable enough to begin regaining the range of motion in your shoulder and elbow. You will know you have a journal article if it is formatted like a science lab: Abstract, Background, Methods, Results, and Discussion.
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The humeral shaft is the middle portion of the bone with the shoulder joint at the top end and the elbow joint at the bottom.
You will probably not be able to raise the arm and the arm will have a tendency to flop and bend.
The fracture is evaluated by taking several x-rays of the upper arm that include the elbow joint and shoulder joint. The surgeon must first decide if the fracture can be reduced to acceptable alignment and held there without surgery.
If your provider makes the assessment that the fracture will heal and give you good arm function without surgery, non-surgical treatment will be recommended. If your provider makes the assessment that the fracture will NOT heal and give you good arm function without surgery, surgical treatment will be recommended.
The intramedullary rod is a long metal rod that is placed inside the hollow shaft of a tubular bone such as the humerus. This type of treatment may be necessary for open fractures when the risk of infection is high. Damage to the radial nerve is uncommon after a humeral shaft fracture, but it is one of the complications that your surgeon will watch for carefully.
The fracture fragments may also heal in an unacceptable alignment; this is called malunion. During the first three to four weeks, you may feel the fracture fragments shift as you move your arm.
If surgery has been required, the rehabilitation program will be modified to protect the fixation of the fracture fragments.


One of the nerves that travels from the neck to the hand, the radial nerve, spirals around the humeral shaft lying very close to the bone about two thirds of the way to the elbow. Other factors will be considered including your age, general health, whether you have osteoporosis and whether this is your dominant arm. Initially the fracture may be treated with a special type of splint called a coaptation splint. If the fracture cannot be held in acceptable position with a hanging cast or fracture brace, surgery may be suggested after several days or weeks of attempting non-surgical treatment. ORIF with a plate and screws is usually the treatment of choice when the radial nerve must be explored, since an incision will need to be made to expose the fracture anyway. The external fixation device allows the surgeon to place metal pins through the skin and into the bone fragments away from the fracture site. Both of these complications may result in pain, loss of strength and a decreased range of motion of the shoulder. Your surgeon will communicate with your physical therapist to make sure that your rehabilitation program does not risk causing the fixation to fail.
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Fractures of the humeral shaft are important because they can injure the radial nerve resulting in the inability to extend (bend) the wrist and fingers backwards. Your provider will also want to make sure that there has been no damage to the radial nerve. If the fracture is an open fracture (also called a "compound" fracture) surgery will be necessary. If the radial nerve was working during the initial evaluation but stops working after treatment by closed reduction, your surgeon may need to perform surgery to make sure that the radial nerve has not become trapped between the bone fragments of the fracture. Your shoulder and elbow may become somewhat stiff because you will not be using the joints normally. If the surgeon feels that the fixation is very solid, you may be able progress your program quickly; if the fixation is not so solid, the speed at which you progress may need to be slowed until more healing occurs. What this means is that even if the fracture fragments do not heal exactly in their normal position the shoulder joint can easily compensate and provide you with a well functioning arm and the bulk of the arm generally hides any residual angulation in the humerus. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. An open fracture occurs when there is a laceration through the skin that connects to the fracture. The splint may be changed to either a hanging cast or a special fracture brace after one to two weeks. If exploration of the radial nerve becomes necessary, the fracture will be fixed surgically as well. The intramedullary rod is inserted with the aid of a special X-ray machine called a fluoroscope. The fracture is stabilized, but there are no foreign materials (such as metal plates) in the fracture site to harbor the infectious bacteria. Physical therapy is usually recommended to regain both strength and range of motion in the shoulder and elbow.
This can be caused by either the ends of the fracture tearing out through the skin or an external object puncturing the skin from the outside.


Both the hanging arm cast and the fracture brace allow the arm to hang by the side; the weight of the arm (and the cast) provides traction that aligns the bone fragments as they heal. The fluoroscope allows the surgeon to see an X-ray image of the bones on a television monitor and guide the placement of the intramedullary rod by viewing this image.
If the radial nerve injury does not heal, then a second operation may be necessary to repair the radial nerve. You can get vitamin D from the foods you eat, such as milk, eggs, and fish, but your body also makes the vitamin when youre exposed to sunlight. Your surgeon must balance the risks and benefits of both surgical and non-surgical treatment, discuss these risks and benefits with you and choose the method that seems to be most appropriate to both of you. You may have to sleep in a recliner for several weeks to allow the weight of the arm to continue to provide traction as you sleep. In some cases a tendon transfer may be required to regain the ability to extend your wrist. You may feel the bone fragments shift as you move; this usually stops by the third week after the fracture. Rickets used to be more common, but mostly disappeared in developed countries during the 1940s due to the introduction of fortified foods, such as cereals with added vitamin D (NIH).
This is when their bodies need the most calcium and phosphate to strengthen and develop their bones. Diet You may be at a higher risk if you eat a vegetarian diet that does not include fish, eggs, or milk, or if you have trouble digesting milk (dairy protein allergy).
Infants who are only fed breast milk can become deficient in vitamin D because breast milk does not contain enough of this nutrient.
Tests to measure blood levels of calcium and phosphate and tests to look at the bones in more depth may help your doctor diagnose rickets.
These tests may include: arterial blood gases blood tests of calcium, phosphorus, parathyroid hormone, and other blood tests bone X-rays Rarely, a bone biopsy is performed. If you are deficient in vitamin D, your doctor will likely tell you to (safely) get more sun and eat foods high in vitamin D, such as: fish liver milk eggs Calcium and vitamin D supplements can also be used to treat rickets. For hereditary rickets, a combination of phosphate supplements and a special form of vitamin D is required to treat the disease.
According to the National Health Service of England (NHS), you only need to expose your hands and face to sunlight a few times a week during the spring and summer months to prevent rickets (NHS). It is important to note that too much sunlight can damage your skin, and sunscreen should be applied to prevent burns and skin damage. Eating foods that contain vitamin D or that are fortified with vitamin D or taking vitamin supplements can also prevent the disease. People with kidney disorders should have their calcium and phosphate levels monitored on a regular basis by their doctors.



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