Humerus Fractures Treatment
The humerus — the single long bone of the upper arm — extends from the shoulder joint above to the elbow joint below, and a fracture can occur at any point along its length. Proximal humerus fractures near the shoulder are the most common, particularly in older adults with osteoporosis who sustain a fall, and are among the most clinically significant because they can involve the rotator cuff attachment points, the joint surface, and the blood supply to the humeral head — all of which affect whether the fracture can heal on its own or requires surgical reconstruction. Mid-shaft humerus fractures through the middle of the bone typically result from direct trauma or a fall and carry the additional concern of radial nerve injury, since the nerve wraps closely around the bone at this level. Distal humerus fractures near the elbow are less common but often involve the joint surface and may require precise surgical restoration to preserve elbow function. The location, displacement, number of fracture fragments, and involvement of the joint surface determine whether a humerus fracture can be treated with immobilization alone or requires surgical fixation or replacement.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with specialized shoulder training that includes a traveling fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins — whose research on proximal humerus fracture classification and management shaped the treatment standards used worldwide — and fellowship training at the Southern California Orthopedic Institute/UCLA. Proximal humerus fractures are particularly complex because the rotator cuff tendons attach directly to the fracture fragments and can pull them apart, and because the blood supply to the humeral head can be disrupted in more severe patterns — creating a risk of avascular necrosis if the fracture is not managed appropriately. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers and a Castle Connolly Top Doctor every year since 2000, Dr. Glashow treats humerus fractures at every level of severity at his Upper East Side practice in New York City, with same-day X-rays and emergency evaluation available.
Types of Humerus Fractures
Proximal Humerus Fractures (Shoulder): These fractures occur at the upper end of the bone, near or within the shoulder joint. The proximal humerus can fracture through the surgical neck, the anatomic neck, or through the greater or lesser tuberosities — the bony prominences where the rotator cuff tendons attach. Proximal humerus fractures are classified by the number of displaced fragments (the Neer classification), which guides treatment decisions. Most one-part and minimally displaced fractures heal with sling immobilization and physical therapy. Two-, three-, and four-part fractures with significant displacement may require open reduction and internal fixation with plates and screws, or in severe cases — particularly in older patients with poor bone quality or a disrupted blood supply to the humeral head — shoulder replacement (hemiarthroplasty or reverse total shoulder arthroplasty).
Mid-Shaft Humerus Fractures: Fractures through the middle of the humerus typically result from a direct blow, a fall, or a high-energy injury. The radial nerve runs in a spiral groove along the back of the humerus at this level and can be injured during the fracture — producing wrist drop (an inability to extend the wrist and fingers). Most mid-shaft fractures can be treated with a functional brace that allows the fracture to heal while permitting elbow and shoulder motion. Surgery with plates, screws, or an intramedullary nail is recommended for fractures that are significantly displaced, open (the bone has broken through the skin), or associated with nerve or vascular injury.
Distal Humerus Fractures (Elbow): These fractures occur at the lower end of the humerus where it forms the elbow joint. Because the distal humerus has a complex shape — with two condyles and the trochlea that articulates with the ulna — fractures in this area often involve the joint surface and require precise anatomic reduction to restore normal elbow mechanics. Surgical fixation with plates and screws is usually necessary for displaced distal humerus fractures.
Symptoms of a Humerus Fracture
- Severe pain in the upper arm immediately after injury
- Swelling and bruising of the upper arm and shoulder or elbow
- Inability to move the shoulder, arm, or elbow
- Visible deformity or shortening of the arm
- Numbness or tingling in the hand or fingers (possible nerve involvement)
- A grinding sensation when attempting to move the arm
Humerus Fracture Treatment in New York City
If you have sustained a fall, direct blow, or traumatic injury to the upper arm and are experiencing severe pain, swelling, or an inability to move your shoulder or elbow, you may have a humerus fracture — and prompt evaluation is essential for determining the right treatment approach. Dr. Glashow offers same-day X-rays and emergency consultation at his Upper East Side practice. Contact our office to schedule your evaluation.
Frequently Asked Questions About Humerus Fractures
How do I know if my upper arm is fractured or just badly bruised?
A humerus fracture typically produces severe, immediate pain that worsens with any attempt to move the arm, rapid swelling and bruising, visible deformity or shortening of the upper arm, and an inability to lift or rotate the arm. A severe bruise can cause significant pain and swelling but generally allows some range of motion and does not produce deformity. Because some non-displaced fractures can be difficult to distinguish from soft tissue injuries without imaging, Dr. Glashow recommends X-rays for any significant upper arm injury — same-day imaging is available at his Upper East Side practice.
Do all humerus fractures require surgery?
No. Many humerus fractures — particularly non-displaced or minimally displaced proximal fractures and most mid-shaft fractures — heal well with non-operative treatment including sling immobilization or functional bracing followed by physical therapy. Surgery is typically recommended when the fracture fragments are significantly displaced, the joint surface is involved, the fracture is unstable or unlikely to heal in acceptable alignment, or when there is an associated nerve or vascular injury. Dr. Glashow evaluates each fracture with X-rays and, when needed, CT imaging to determine whether surgical or non-surgical treatment will produce the best outcome.
What does surgery for a humerus fracture involve?
The surgical approach depends on the fracture location and pattern. Proximal humerus fractures are typically repaired with open reduction and internal fixation using plates and screws to restore the anatomy of the shoulder joint. In cases where the fracture is too severe to reconstruct — particularly in older patients with poor bone quality — shoulder replacement surgery (hemiarthroplasty or reverse total shoulder arthroplasty) may be the most reliable option. Mid-shaft fractures may be fixed with plates and screws or an intramedullary nail. Distal humerus fractures near the elbow are fixed with plates and screws to restore the joint surface precisely.
What is the risk of nerve damage with a humerus fracture?
The radial nerve is the nerve most commonly at risk, particularly with mid-shaft humerus fractures — it runs in a spiral groove along the back of the bone and can be stretched, bruised, or trapped by the fracture fragments. Radial nerve injury produces wrist drop — an inability to extend the wrist and fingers — and numbness on the back of the hand. In most cases, the nerve is bruised rather than severed and recovers on its own over weeks to months. Dr. Glashow evaluates nerve function as part of the initial fracture assessment and monitors recovery, recommending surgical exploration only if the nerve does not show signs of recovery within an expected timeframe.
How long does it take for a humerus fracture to heal?
Most humerus fractures take six to twelve weeks to achieve sufficient bony healing, though full strength and range of motion may take several months of rehabilitation. Non-displaced fractures treated with a sling typically begin gentle range-of-motion exercises within the first few weeks. Surgically repaired fractures follow a rehabilitation protocol tailored to the type of fixation used. Physical therapy is essential for restoring shoulder and elbow mobility — particularly after proximal humerus fractures, where stiffness is a common concern. Dr. Glashow coordinates rehabilitation closely with physical therapists to balance early motion with fracture protection.
Can a humerus fracture lead to long-term shoulder problems?
Proximal humerus fractures that involve the joint surface or disrupt the blood supply to the humeral head can lead to post-traumatic arthritis, avascular necrosis (bone death from loss of blood supply), or chronic stiffness if not treated appropriately. The risk increases with the severity and complexity of the fracture. Proper initial treatment — whether surgical or non-surgical — and a complete rehabilitation program are the most important factors in preventing long-term complications and restoring full shoulder function.
