Humeral Shaft Fractures in Elderly Patients: Care and Recovery

Fall, mid-shaft humeral fracture?

Hello Doctor: My grandmother (85 years old) fell and fractured the middle of her left humerus when she was admitted to the hospital.
The doctor advised against surgery due to her age and poor recovery ability.
She has been cared for for over a year, and a recent X-ray shows some improvement, with the bone ends appearing closer together, and she has not experienced pain for the past year.
We have been using traditional Chinese medicine for bone manipulation, which has been effective and painless.
However, the bone manipulator mentioned that the healing process will take time, and she must continue to use a hard white brace to stabilize her arm, secured with a white cloth around her neck to maintain elevation.
Recently, we consulted another doctor who stated that a fracture in the middle of the humerus cannot heal back into a perfectly straight bone and will resemble having an additional joint in the middle.
This was not mentioned by previous doctors, and I would like to confirm if this is indeed true.
Currently, we are unsure if my grandmother can use her left arm normally.
Is it necessary to keep her arm immobilized and secured, or should we encourage more movement? She feels weak from being restrained and is reluctant to move, becoming increasingly lethargic and feeling as if she is nearing the end of her life...
Our family is at a loss about what to do...
Please help clarify this situation!

Natalie, 20~29 year old female. Ask Date: 2020/11/07

Dr. You Dianqi reply Orthopedics

Hello, the phenomenon you mentioned in medicine is called pseudoarthrosis.
If there has been incomplete healing at the fracture site, this is a possibility.
As for your grandmother, I would need to review some of her basic imaging before I can provide you with sound advice regarding her activity level.
However, generally speaking, for a fracture that has been present for over a year, my sincere recommendation would not deviate from existing considerations.
The most important thing is to help your grandmother regain joy in life in a way that is convenient and comfortable for her.
First, ask her what activities she prefers, and then discuss with her physician whether those activities are feasible.
Patient-centered care is the essence of medicine.
Thank you, and I wish her a speedy recovery.

Reply Date: 2020/11/07

More Info

Understanding humeral shaft fractures in elderly patients, particularly in the context of your grandmother's situation, requires a comprehensive approach that considers both the medical and emotional aspects of recovery.
Humeral shaft fractures can be particularly challenging in elderly patients due to factors such as decreased bone density, slower healing processes, and the presence of comorbidities. In your grandmother's case, the decision not to proceed with surgical intervention was likely influenced by her age and overall health status. Non-surgical management, which often includes immobilization and physical therapy, is a common approach for elderly patients with these types of fractures.

From your description, it sounds like your grandmother has been in a long-term immobilization state with a hard cast and a sling. While immobilization is crucial in the initial stages of healing to prevent further injury and allow the bone to mend, prolonged immobilization can lead to muscle atrophy and stiffness in the joint. This is particularly concerning in elderly patients, as they may already have diminished muscle mass and strength.

Regarding the healing process, it is true that humeral shaft fractures may not heal perfectly aligned, especially in older adults. The bone may heal in a slightly angulated or malaligned position, which can lead to functional limitations. However, this does not necessarily mean that the arm will be unusable. Many patients can regain significant function even if the bone does not heal in a perfect anatomical position. The key is to focus on rehabilitation and physical therapy once the initial healing has occurred.

Here are some important considerations for your grandmother's care and recovery:
1. Regular Follow-Up: Continuous monitoring through follow-up X-rays is essential to assess the healing process. If the bone is showing signs of healing and there is no pain, this is a positive indicator.

2. Gradual Mobilization: While it is important to keep the arm immobilized initially, once the doctor confirms that the fracture is healing, gentle range-of-motion exercises should be introduced. This can help prevent stiffness and improve circulation. It is crucial to work with a physical therapist who can guide you through appropriate exercises tailored to her condition.

3. Pain Management: If your grandmother is experiencing discomfort, it is important to address this with appropriate pain management strategies. This may include medications or alternative therapies, such as acupuncture or gentle massage, as advised by her healthcare provider.

4. Emotional Support: The psychological impact of prolonged immobilization can lead to feelings of helplessness and depression. Encouraging social interaction, engaging in light activities that she enjoys, and providing emotional support can help improve her outlook and motivation.

5. Nutrition: Ensuring that your grandmother has a balanced diet rich in calcium and vitamin D is vital for bone health. Nutritional support can aid in the healing process and overall well-being.

6. Consultation with Specialists: If there are concerns about her recovery, consider seeking a second opinion from an orthopedic specialist who has experience with geriatric patients. They can provide insights into the best course of action moving forward.

In conclusion, while the healing of a humeral shaft fracture in an elderly patient may not result in a perfectly aligned bone, with appropriate care, rehabilitation, and support, your grandmother can still achieve a functional range of motion and improve her quality of life. It is essential to balance immobilization with gradual mobilization and to provide emotional and nutritional support throughout her recovery journey.

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