Upper Limb Fracture
An upper limb fracture occurs when one of the bones in your arm breaks, from your shoulder down to your hand and fingers. These breaks can range from small cracks to bones broken into multiple pieces, and while they’re often caused by serious accidents, proper treatment can help restore full function of your arm.
Table of contents
- What Is an Upper Limb Fracture?
- Anatomy of the Upper Limb
- Types of Fractures
- Common Causes
- Signs and Symptoms
- How Fractures Are Diagnosed
- Treatment Options
- Recovery and Healing Time
What Is an Upper Limb Fracture?
An upper limb fracture is a medical term for a break or crack in any of the bones of your arm. This includes bones in your hand, fingers, wrist, forearm, elbow, upper arm, or shoulder[1]. The term “broken arm” may refer to a fracture (the medical name for a break) in any of these bones[7].
Upper limb fractures are very common injuries. Fractures in the hand and foot account for about 60% of all fracture cases, while fractures in the forearm bones represent about 20% of cases[3]. These injuries can affect anyone, though they’re particularly common in certain age groups and situations.
Anatomy of the Upper Limb
- Scapula (shoulder blade)
- Clavicle (collarbone)
- Humerus (upper arm bone)
- Radius (forearm bone on thumb side)
- Ulna (forearm bone on pinky side)
- Carpal bones (wrist bones)
- Metacarpal bones (hand bones)
- Phalangeal bones (finger bones)
The upper limb consists of several bones that work together to allow a wide range of movement[3][6]. Your arm is made up of three main bones: the humerus (upper arm bone) and two forearm bones called the ulna and radius[7]. The humerus is the only bone in your upper arm and extends from your shoulder to your elbow. Because it’s so strong, it usually takes the force of a serious trauma like a fall or car accident to break it[4].
Types of Fractures
Fractures in the upper limb can be classified in several different ways based on various factors[3][5]. Understanding these classifications helps doctors determine the best treatment approach.
Based on skin integrity: A closed fracture occurs when the bone breaks but the skin remains intact. An open fracture (also called a compound fracture) happens when the bone breaks through the skin, creating a significant risk of infection[1][3]. Open fractures usually take longer to heal and have an increased risk of complications[4].
Based on bone alignment: A displaced fracture means the bone fragments have moved so much that a gap formed when the bone broke. The pieces are no longer aligned properly. A non-displaced fracture means the bone is broken but the pieces haven’t moved far out of position[1][4]. Displaced fractures are much more likely to require surgery.
Based on fracture pattern: Different fracture patterns are named based on how the bone breaks[4][5]:
- Transverse fracture: The break occurs as a straight, horizontal line across the bone
- Oblique fracture: The break occurs at an angle across the bone
- Spiral fracture: Caused by a twisting force, with a fracture line that spirals around the bone
- Comminuted fracture: The bone breaks into three or more pieces
- Hairline fracture: A very small, thin crack in the bone
- Stress fracture: Small cracks caused by overuse or repetitive force
Based on joint involvement: An intra-articular fracture extends into a joint, such as the wrist or elbow, which may affect joint function[1].
Common Causes
Upper limb fractures occur when mechanical force is applied to the bone, either from trauma or due to weakened bone structure[3]. The most common cause is falling onto an outstretched hand, which happens when someone tries to catch themselves during a fall[7].
- Falls from standing height or from a height
- Motor vehicle collisions
- Contact sports injuries
- Pedestrian versus automobile accidents
- Direct blow to the arm
- Landing on an outstretched arm during a fall
Pathological fractures can also occur when bones are weakened by disease. These fractures happen more easily, sometimes from minor trauma or even normal activities. Conditions that can weaken bones include tumors, infections like tuberculosis or osteomyelitis, osteoporosis (often due to hormonal changes or long-term hormone treatment), and other bone diseases[3].
Signs and Symptoms
The signs and symptoms of an upper limb fracture can vary depending on the severity and location of the break[1]. Common symptoms include[3][5][7]:
- Severe pain that may increase with movement
- Swelling around the injury site
- Bruising or tenderness
- Visible deformity, such as a bent arm or wrist
- Inability to move the affected area normally
- Difficulty or inability to turn your arm from palm up to palm down
- Loss of feeling or numbness
- Weakness in the arm or hand
- A snap or cracking sound at the time of injury
If the bone is no longer straight or you hear a cracking sound called crepitation when the bone fragments rub together, these are strong signs of a fracture[3]. Some fractures may also cause abnormal or pathological motion—movements that shouldn’t normally be possible at that location[3].
How Fractures Are Diagnosed
To diagnose an upper limb fracture, your doctor will first review your symptoms and medical history, then perform a thorough physical examination[5][7]. During the physical exam, the doctor will check for tenderness, swelling, deformity, or open wounds, and examine your arm for signs of bruising or skin damage.
Imaging tests are essential to confirm the diagnosis and determine the exact type and location of the fracture[1][5]:
X-rays are the most common diagnostic tool. They use electromagnetic energy beams to create images of your bones, showing whether the bone is broken, what type of fracture it is, and exactly where it’s located[1][5].
CT scans (computed tomography) use special x-rays to produce cross-sectional images of your limb. These scans provide clearer, more detailed images of damage that might not be visible on regular x-rays[1][5].
MRI scans (magnetic resonance imaging) use large magnetic fields and radio waves to create detailed images. These are particularly helpful for detecting damage to soft tissues like muscles, tendons, and ligaments around the fracture[1][5].
Treatment Options
The treatment approach for an upper limb fracture depends on the type and severity of the break[5]. During the period of skeletal development in children and adolescents, both conservative and surgical treatments are used in a complementary way[10].
Non-Surgical Treatment
Many upper limb fractures can be effectively treated without surgery[4]. Non-surgical options include[5]:
Casting and splinting: A cast or splint holds the broken bone fragments in the proper position while the bone heals. These devices are typically made of plastic, fiber, or Velcro that wraps around the affected limb to support, stabilize, and protect the injured bones and joints[5]. You may need to wear a sling or shoulder immobilizer, and avoid moving the shoulder for at least two weeks[18].
Closed reduction: For severe fractures where the bones haven’t broken through the skin but are significantly angled, your doctor may gently manipulate and realign the bone fragments. This procedure helps ensure proper healing without surgery[5].
Traction: This method may be used if there’s significant misalignment. It involves placing the limb in a weight and counterweight system to ensure the bones are realigned and stabilized properly[5].
Surgical Treatment
Some fractures require surgery to ensure proper healing. Surgery may be necessary for displaced fractures, open fractures, or fractures that extend into joints[1]. Surgical treatment can help bring about healing while preserving the function of the arm[1].
The main goals of treatment are to heal the fracture and preserve limb function. In children and adolescents, doctors must also consider the growth that will occur during the remaining period of skeletal development[10].
Pain Management
Alleviating pain is the first step in fracture management[10]. Your doctor may prescribe pain medications or recommend over-the-counter options to help manage discomfort during healing.
Recovery and Healing Time
Recovery time for an upper limb fracture varies based on several factors, including the type and location of the break, your age, overall health, and whether surgery was needed. A broken arm typically takes about six weeks to heal, though recovery time can be shorter or longer depending on these factors[20].
Fractures in children and adolescents heal much more rapidly than in adults because bone is a dynamically growing organ during skeletal development[10]. However, it usually takes several weeks to months for a complete recovery, and you may need a few months to recover from a fractured humerus depending on the type of fracture and any other injuries[4].
Physical Therapy and Rehabilitation
Physical therapy plays a crucial role in recovery. Your physical therapist will design a program to increase your arm’s range of motion, build muscle strength, and improve flexibility[18]. You’ll need physical therapy to regain your ability to move your arm properly[4].
The recovery process typically includes wearing a more flexible brace after the initial healing period and working with a physical therapist. X-rays will be taken periodically to ensure the bone is healing correctly[18].
Important aspects of recovery include[1]:
- Surgery when necessary
- Chronic pain management if needed
- Therapy services to improve your body’s function and movement
Recovery Tips
To support healing, eat a variety of healthy foods and don’t smoke, as this helps your body heal best[13]. Recovery goes better when you follow your doctor’s orders and stay as active as safely possible[15].
Follow-up care is essential for proper healing and safety. Make sure to attend all scheduled appointments, and contact your doctor if you experience problems during recovery[13].
