treatment

Last reviewed 01/2018

Conservative treatment is usually effective as the fragments are held in position adequately by the surrounding soft tissue. Neither perfect reduction nor immobilisation is necessary.

A hanging cast - shoulder to wrist with the elbow in flexion to 90 degrees - is given to protect the humerus from further trauma, and is then supported by a collar and cuff - not a sling. The combined weight of the arm and the cast applies enough traction to the fracture site to align the bony fragments. The cast is worn for 2-3 weeks and then replaced by either a shorter - shoulder to elbow - cast or a functional polypropylene brace, for a further 6 weeks. Active abduction is withheld until the fracture is united but pendulum exercises of the shoulder should be begun after 1 week. Rarely, an external fixator may be used.

Internal fixation - usually a plate and screws, or an intramedullary nail - may be advocated in:

• unstable fractures
• pathological fractures

Most fractures take from 4-6 weeks to heal but spiral fractures may take slightly longer.