Humerus Fracture: Symptoms, Types, Causes and Treatment

Fractures of the humerus—one of the longest bones in the body—can affect anyone, from energetic children to active adults and elderly individuals. Whether resulting from trauma, falls, or even certain medical conditions, humerus fractures require prompt recognition and tailored care. In this article, we break down the key symptoms, the main types, underlying causes, and evidence-based treatments for humerus fractures, giving you a clear, comprehensive overview of this common injury.

Symptoms of Humerus Fracture

Recognizing a humerus fracture early is crucial for effective treatment and recovery. Humerus fractures often present with a range of symptoms that can vary depending on the fracture's location and severity. Understanding these symptoms helps individuals seek timely medical attention and avoid complications.

Symptom	Description	Severity/Notes	Source(s)
Pain	Sharp, intense at fracture site	Worsens with movement	1, 2, 4, 7
Swelling	Localized swelling and bruising	May include visible deformity	1, 4, 7
Limited Motion	Difficulty moving arm/shoulder/elbow	Stiffness and reduced function	3, 4, 7
Nerve Symptoms	Numbness, tingling, weakness	Axillary/ulnar nerve involvement	2, 4, 7
Vascular Signs	Cold, pale hand; weak pulse	Vascular compromise possible	7

Table 1: Key Symptoms

Pain and Swelling

The most immediate and universal symptom of a humerus fracture is pain. This pain is typically severe, localized at the fracture site, and worsens when trying to move the arm. Swelling and bruising often accompany the pain, and in severe cases, there may be a visible deformity or abnormal angulation of the arm 1, 4, 7.

Limited Motion and Functional Loss

A fractured humerus often leads to a loss of normal movement in the shoulder, arm, or elbow. This may present as stiffness, inability to lift or rotate the arm, or difficulty performing everyday tasks 3, 4, 7. In children, refusal to use the arm or holding it immobile is common.

Nerve and Vascular Signs

Some fractures, particularly those near the elbow or shoulder, can injure nearby nerves or blood vessels. Axillary nerve injury, common in proximal humerus fractures, may cause numbness over the shoulder or weakness in the deltoid muscle 2. Flexion-type supracondylar fractures, though rare, are more likely to involve the ulnar nerve 4, 7. Vascular compromise, while less common, can lead to a cold, pale hand and diminished pulses, requiring urgent intervention 7.

Types of Humerus Fracture

Humerus fractures are diverse, and their classification depends on the fracture's location, pattern, and involvement of the bone or joint surfaces. Understanding the main types is important for diagnosis and for guiding treatment decisions.

Type	Location/Pattern	Common Patients	Source(s)
Proximal	Near shoulder	Elderly, children	3, 13, 14, 17
Shaft	Middle section	Adults, athletes	9, 15
Distal	Near elbow	Children, elderly	5, 6, 7, 11
Supracondylar	Just above elbow joint	Children	4, 7, 8, 11
Tuberosity	At greater/lesser tuberosity	Active adults	10

Table 2: Main Types of Humerus Fracture

Proximal Humerus Fractures

Located near the shoulder, proximal humerus fractures are particularly common in older adults, often due to falls. They can range from simple non-displaced breaks to complex multi-part injuries. In children, these fractures are rare but can result from significant trauma 3, 13, 14, 17.

Shaft Fractures

The humeral shaft is the long, central part of the bone. Shaft fractures can occur from direct blows, twisting injuries, or even high-force athletic activities like throwing. These fractures can be simple (spiral, transverse) or complex (comminuted, with multiple fragments) 9, 15.

Distal Humerus Fractures

Distal fractures occur near the elbow and are less common in adults, but their incidence is increasing among the elderly. In children, these fractures often involve the growth plate and can be associated with elbow dislocations. Distal fractures are classified as nonarticular, partial articular, or complete articular, with further subclassification based on the fracture line's orientation 5, 6, 11.

Supracondylar Fractures

Supracondylar fractures, just above the elbow joint, are the most frequent elbow fractures in children, especially those aged 5–8 years. Extension-type fractures make up the vast majority, while flexion-type fractures are rare but often more severe and more likely to cause nerve injuries 4, 7, 8.

Tuberosity Fractures

Fractures of the greater or lesser tuberosity, where the rotator cuff attaches, usually result from shoulder dislocations or direct trauma. These are more common in adults involved in high-impact activities or falls 10.

Causes of Humerus Fracture

The causes of humerus fractures vary widely with age, activity, and underlying health conditions. Understanding these mechanisms is critical for prevention and early recognition.

Cause	Description	Typical Population	Source(s)
Falls	From height, standing, or playground	Children, elderly	8, 14, 15
Direct Trauma	Blunt force, car accidents, sports injuries	All ages	9, 15
Twisting Injury	Throwing or rotational force	Athletes, young adults	9
Abuse	Non-accidental injury	Young children	11
Seizures	Convulsive muscle contractions	Adults with epilepsy	12
Pathology	Bone weakness (osteoporosis, tumor)	Elderly, cancer pts	13, 14

Table 3: Common Causes of Humerus Fracture

Falls

Falls are the most common cause of humerus fractures, particularly in children and older adults. In children, falls from playground equipment or household furniture are frequent culprits, while elderly individuals often sustain fractures from ground-level falls due to osteoporosis and reduced bone strength 8, 14, 15.

Direct Blunt Trauma

High-energy trauma, such as car accidents or contact sports, can cause humerus fractures at any age. These injuries often result in more complex or comminuted fractures and may be associated with other injuries 9, 15.

Twisting and Rotational Injuries

Specific activities, such as forceful throwing in baseball, can cause spiral fractures of the humeral shaft. These injuries are well-documented among recreational athletes and can also lead to associated nerve injuries 9.

Abuse in Children

Non-accidental trauma should always be considered in very young children with unexplained fractures, especially those who are not yet ambulatory. Certain fracture patterns, such as transverse or oblique fractures of the distal humerus, may raise suspicion for abuse 11.

Seizures and Pathological Fractures

Severe convulsive seizures can generate enough force to cause proximal humerus fractures, sometimes without other trauma. Additionally, weakened bones from osteoporosis or tumors can fracture with minimal force 12, 13, 14.

Treatment of Humerus Fracture

Treatment of humerus fractures is highly individualized, depending on factors like patient age, fracture type and location, displacement, and overall health. The primary goals are to restore function, minimize pain, and prevent complications.

Treatment	Indication/Approach	Typical Outcome	Source(s)
Nonoperative	Most non-displaced/stable fractures	Good/excellent results	13, 14, 15, 16, 17
Surgical Fixation	Displaced, unstable, or complex fractures	Early mobility, stable fixation	13, 16, 17
Sling/Cast	Neck/shaft, non-displaced	Early exercise important	15, 16, 17
Pins/Plates	Displaced, comminuted, pediatric severe	High success with ESIN	7, 13, 16, 17
Arthroplasty	Severe, elderly, multi-part	Used if fixation fails	13, 14

Table 4: Treatment Approaches

Nonoperative Management

Most humerus fractures, especially those that are non-displaced or minimally displaced, can be managed without surgery. Treatment typically involves:

• Immobilization with a sling or cast
• Early, controlled exercises to prevent stiffness
• Pain management and regular monitoring for complications

In elderly patients with proximal humerus fractures, nonoperative treatment often yields similar outcomes to surgery, with fewer risks 13, 14, 15, 16.

Surgical Treatment

Surgery is indicated for displaced, unstable, or complex fractures, as well as those involving nerve or vascular injury. Surgical options include:

• Closed reduction and percutaneous pinning (especially in pediatric supracondylar fractures) 7
• Open reduction with internal fixation (ORIF) using plates, screws, or intramedullary nails for unstable or comminuted fractures 13, 16
• Elastic Stable Intramedullary Nailing (ESIN) in children with severely displaced proximal humerus fractures, showing high success rates 17
• Arthroplasty (shoulder replacement) for severe multi-part fractures in the elderly, especially when fixation is not feasible 13, 14

Careful patient selection and meticulous surgical technique are essential to minimize complications such as nerve injury, infection, or implant failure 13, 14, 16, 17.

Rehabilitation and Follow-Up

Early and supervised rehabilitation is crucial for all patients to restore range of motion and function. Physical therapy should be tailored to the individual, with regular follow-up to monitor healing and identify complications such as malunion, nonunion, or persistent pain 10, 13, 16.

Conclusion

Humerus fractures are common injuries with diverse presentations and causes. Successful management depends on accurate diagnosis, recognition of complications, and a personalized treatment approach.

Key takeaways:

• Symptoms: Include pain, swelling, limited motion, and possible nerve or vascular involvement.
• Types: Classified by location—proximal, shaft, distal, supracondylar, and tuberosity.
• Causes: Range from falls and direct trauma to twisting injuries, abuse, seizures, and bone pathology.
• Treatment: Most non-displaced fractures heal well with nonoperative care; surgical intervention is reserved for complex, unstable, or complicated cases. Early rehabilitation is vital for optimal recovery.

Whether you're a patient, caregiver, or healthcare professional, understanding the nuances of humerus fractures can guide better outcomes and informed decisions.