Fractures of the humeral shaft are fairly common. Elderly patients with weaker bone can break their arm with relatively low levels of force (e.g. a simple fall) , but younger patients tend to require powerful twisting or bending forces to break their humerus.
Most humeral shaft fractures do not require surgery. If you don't require surgery you will be fitted with a humeral brace (a moulded plastic brace) and a sling. This helps to stabilise your broken bone and allows you to move your elbow gently to avoid that getting stiff while your fracture heals. Approximately 90% of well-selected humeral shaft fractures will heal without surgery. It takes approximately 12 weeks for bony healing in most cases.
Some fractures will benefit from early fixation.
- Open fractures (where your bone comes out of the skin) need urgent surgery to washout any contamination, fix the fracture and minimise infection risk.
- Transverse fractures carry a higher risk of non union if left alone, so in Mr Granville-Chapman's hands, these are normally fixed.
- Displaced fractures that lie near the elbow will normally heal, but deformity may be hard to tolerate and elbow stiffness is a problem. Again, Mr Granville-Chapman will normally offer surgery to fix these injuries.
- Some fractures are hard to control with a brace because of their location near the armpit. If an acceptable position cannot be maintained in a brace, you may require surgical fixation.
The first couple of weeks will be the most sore; thereafter your pain and swelling should begin to subside. Initially you will want your sling and brace. You will be shown very simple gentle exercises for your arm that will keep your shoulder and elbow supple. As your fracture begins to heal, your arm will feel more solid and you will probably be happy to wean off your sling. Please maintain your brace until asked to remove it.
You will not be ready to drive for eight weeks or more and you will need to be off work for at least two weeks for a desk-based job. Manual work will take at least three months.
The radial nerve is one of the three main nerves that supplies your forearm and hand. It wraps closely around the back of your humerus in its mid-shaft as it travels from your armpit to your forearm. This nerve supplies the muscles that extend (lift up) your wrist and fingers. It also supplies the skin's sensation over most of the back of your hand.
A radial nerve injury is present in 11% of humeral shaft fractures, with certain fracture patterns having carrying an even higher risk of injury. The injury happens as the nerve, which is tethered by some tough fibrous tissue a few centimetres lower down your arm, gets stretched by the fracture displacement, or directly injured by sharp fracture fragments. The nerve can also get caught in the fracture site and squashed.
Often patients will report pins and needles, or frank numbness over the back of their hand and a dropped wrist.
Thankfully the nerve is normally bruised and stretched and not cut. While this bruising and stretching can stop the nerve from working, over 90% of these injuries will recover. It is generally therefore accepted that a radial nerve injury with a humeral shaft fracture is not on its own a reason to operate. However, this recovery can take a long time as regeneration of the damaged nerve fibres inside the nerve occurs slowly (1mm a day). It may therefore be several months before all your muscles regain power. If your nerve is injured, and you require surgery for your fracture (e.g. the fracture displacement or pattern warrants an operation), then your nerve will be explored to confirm it's intact and free from entrapment.
Until your motor recovery, you will benefit from a wrist splint to keep your hand and wrist in a functional position and you will be given exercises to keep your joints supple. Your surgeon will follow your recovery closely. If there is no sign of nerve recovery, you will be sent for nerve testing. This will give a good idea of the state of the nerve and it is often helpful in terms of prognosis. Very rarely, the nerve will need to be surgically explored, freed of scar tissue and even more rarely grafted at a later date. If your nerve is not recovering you may also require tendon transfer surgery to restore wrist and finger function to your hand.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
Spire Thames Valley hospital
Wexham Street, Wexham, Buckinghamshire, SL3 6NH
Wexham Park Hospital, Slough, Berkshire, SL2 4HL
BMI The Princess Margaret Hospital
Osborne Rd, Windsor SL4 3SJ