Introduction to Mid Humeral Fractures
A mid-humeral fracture — a break in the middle portion of the upper arm bone — is a relatively common injury, accounting for around 1–3% of all fractures and approximately 20% of humeral fractures in the UK. These injuries are frequently seen across all age groups. In younger adults, they are often the result of high-energy trauma, such as contact sports, cycling or motorbike crashes, or workplace accidents.
In older adults, they are more likely to result from low-energy falls, often linked to reduced bone density or osteoporosis. Early, accurate diagnosis and appropriate management are key, as the location and pattern of the fracture can influence recovery time and the likelihood of complications.
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What and where is the Humerus?
The humerus is the long bone of your upper arm, running from your shoulder down to your elbow. It forms part of two important joints — the shoulder joint at the top and the elbow joint at the bottom — and plays a vital role in almost every arm movement, from lifting and pushing to throwing and reaching.
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In the context of mid-humeral fractures, the break happens along the shaft, or middle section, of the bone — between the shoulder and elbow joints. This area is particularly important because of its relationship to surrounding muscles and the radial nerve, which runs close to the bone and can occasionally be affected when the bone breaks.
Types of Mid Humeral Fracture
In the UK, humeral shaft (mid-humeral) fractures are most commonly classified using the AO/OTA fracture classification system. This system divides fractures into three main types (A, B, C) according to the complexity of the break, and each type can be further sub-categorised. This classification is widely used in both trauma centres and orthopaedic practice across the NHS, as it standardises communication, guides management, and is used in audit and research.
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Type A – Simple Fractures
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Description: The bone is broken in a simple line, leaving two main fragments. The cortex is intact apart from the fracture line.
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Sub-types:
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A1: Simple spiral fracture
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A2: Simple oblique fracture
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A3: Simple transverse fracture
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Clinical notes (UK context):
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Often seen in younger patients after torsional injuries (e.g., sports, falls).
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Many can be managed non-operatively with functional bracing, provided there is acceptable alignment.
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Type B – Wedge Fractures
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Description: There is an additional wedge-shaped fragment between the main fracture pieces. The wedge may be intact or fragmented.
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Sub-types:
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B1: Spiral wedge
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B2: Bending wedge
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B3: Fragmented wedge
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Clinical notes (UK context):
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Common in road traffic accidents or high-energy falls.
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Stability depends on whether the wedge remains attached — if unstable, surgical fixation may be required.
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NICE guidance emphasises careful neurovascular assessment as wedge fragments can increase the risk of radial nerve palsy, a recognised complication in humeral shaft fractures.
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Type C – Complex (Comminuted) Fractures
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Description: The bone is broken into multiple pieces, often with no single large fragment carrying the full load.
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Sub-types:
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C1: Spiral complex fracture
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C2: Segmental fracture
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C3: Irregular, highly comminuted fracture
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Clinical notes (UK context):
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Frequently seen in older patients with osteoporosis after low-energy falls, or in younger patients after severe trauma.
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These almost always require operative fixation (plate, nail, or external fixation) due to instability.
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In the UK, NICE and BOA (British Orthopaedic Association) guidelines support surgical intervention when non-operative management is unlikely to achieve union or functional outcome.​​
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Causes of Mid Humeral Fractures
Several factors can cause mid humeral fractures, including:
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Direct Blow or Bending Force: A direct impact to the middle of the humerus, such as from a car accident or a heavy blow during contact sports, can cause the bone to break.
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Falling onto an Outstretched Arm: A common cause of fractures, especially in the elderly, is falling and landing on an outstretched hand. The force travels up the arm and can result in a break in the humerus.
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Violent Muscle Contraction: In sports such as weightlifting, a sudden and violent contraction of the muscles can exert enough force to fracture the humerus.
Signs & Symptoms of a Mid Humeral Fracture
Patients with a mid humeral fracture typically present with:
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Considerable Pain: Intense pain at the site of the fracture that worsens with movement.
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Swelling: Significant swelling around the injured area.
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Shortening of the Arm: Visible shortening of the arm due to displacement of the bone fragments.
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Deformity: An abnormal appearance of the arm, with possible visible misalignment.
Ensuring Optimal Treatment Outcomes
At Team Rehab UK, we emphasise that treatments which are not effective should not continue beyond accepted clinical timescales without further in-depth investigations. We prefer these additional assessments to be conducted by consultant specialists outside our company’s financial interests. This approach ensures we receive an unbiased second opinion, guaranteeing that the care you receive is the most clinically appropriate.
Diagnosing a Mid Humeral Fracture
Accurate diagnosis is crucial for effective treatment. The diagnostic process typically involves:
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Medical History and Physical Examination
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Initial Consultation:
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Your specialist in Northampton will begin by reviewing your symptoms and medical history to understand the circumstances of the injury.
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Physical Examination:
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A thorough physical exam will be conducted to assess the Humeral fracture. This includes palpating the area to pinpoint tenderness and deformity and evaluating the range of motion and stability of the shoulder.
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Imaging Tests
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X-rays:
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Confirmation and Assessment: X-rays are commonly used to confirm the presence of a fracture, determine its severity, and locate the exact site of the break. They reveal the alignment of the bone fragments and any displacement.
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CT Scan:
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Detailed Imaging: In more complex cases, a CT scan might be ordered to provide detailed images of the bone and surrounding structures, offering a comprehensive view of the fracture.
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Treatment Options
Conservative Treatment
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Most mid humeral fractures can be treated successfully without surgery using conservative methods:
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Immobilisation:
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Hanging Arm Cast or Coaptation Splint: Initially, the arm may be immobilised in a hanging cast or splint for 1-3 weeks to allow the bones to begin healing.
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Functional Brace: After the initial period, a functional brace is used to support the arm while allowing for some movement.
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Pain Management:
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Pain relievers and anti-inflammatory medications help manage discomfort.
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Physiotherapy:
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Early initiation of range of motion exercises for the fingers, wrist, elbow, and shoulder is encouraged as soon as it can be tolerated to prevent stiffness and maintain mobility.
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Surgical Treatment
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Surgery may be necessary for more severe fractures or when conservative treatment is not sufficient. Indications for surgical treatment include:
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Fractures That Cannot Be Managed Conservatively: When the bone fragments are too displaced to heal properly without surgical intervention.
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Segmental Fractures: When the bone is broken in multiple places along its length.
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Pathologic Fractures: Fractures caused by underlying conditions such as bone tumours.
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Injury to Blood Vessels: When the fracture causes damage to blood vessels.​
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Open Fractures: When the broken bone pierces through the skin, increasing the risk of infection.
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Obese Patients: In whom proper alignment is difficult without surgery.
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Surgical Procedure:
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Open Reduction and Internal Fixation (ORIF). The ORIF procedure is performed under general anaesthesia and involves:
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Incision: An incision is made over the fracture site to access the broken bones.
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Fracture Alignment: The broken bones are realigned to their normal anatomical position.
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Fixation: Internal fixation devices such as plates, screws, or intramedullary (IM) implants are used to hold the bones in place.
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Fluoroscopy: Live X-ray guidance ensures accurate placement of the fixation devices.
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Closure: The incision is sutured, and a dressing is applied.
Post Surgical Care
Following surgery, proper post-operative care is essential for recovery:
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Numbness: Temporary numbness below the incision area is common and usually resolves over time.
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Physiotherapy: Early rehabilitation is critical:
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Gentle Motion Exercises: Initially, exercises focus on restoring gentle motion to prevent stiffness.
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Strengthening Exercises: As healing progresses, exercises aim to strengthen the shoulder and restore full function.
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Gradual Resumption of Activities: Regular activities can typically be resumed after about three months, but it is important to avoid strenuous activities and heavy lifting until full healing is confirmed.
Risks and Complications
As with any surgical procedure, complications can occur. Potential risks include:
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Nerve Injury: Possible damage to surrounding nerves during surgery.
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Bleeding: Excessive bleeding during or after the procedure.
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Infection: Risk of infection at the surgical site.
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Blood Clots: Formation of blood clots, particularly in the legs (deep vein thrombosis).
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Recurrent Instability: Potential for the bone to become unstable again.
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Malunion or Non-Union: Improper healing of the bone, either in the wrong position or not healing at all.
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Hardware Failure: Breakage or malfunction of the fixation devices.
We have included this video animation to help you visualise the anatomy that we, as professionals, often take for granted. At Team Rehab UK, we are dedicated to helping our patients understand the causes of their symptoms, empowering them to effectively manage their condition both during and after their treatment.
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Please note that some of our videos may be of American origin and might contain slightly different professional terms or approaches compared to those used in the UK. However, the content remains highly informative and beneficial. You should seek advice form your UK based specialist before trying any advice contained, or inferred, in the video you ensure it complies with UK best practice standards.
Summary
Mid humeral fractures can be managed effectively through both conservative and surgical methods, depending on the type and severity of the fracture. With a union rate of up to 90%, proper treatment and rehabilitation can result in a successful recovery.
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If you're experiencing symptoms of a mid humeral fracture, you should consult with a consultant for x-rays. Following this acute care diagnosis and management, when advised it is safe to do so you will be able to consult with a physiotherapist in Northampton for a thorough evaluation and personalised treatment plan.
At our clinic, we offer comprehensive physiotherapy in Northampton, including sports massage in Northampton, to help you recover effectively. We are recognised providers for Bupa Northampton and Axa Northampton, ensuring quality care for our patients. Reach out to our shoulder specialists in Northampton for expert care and support.
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Book your appointment at Team Rehab uk in Northampton (Brixworth) or Corby, and take the first step towards a pain-free life. Share this information with friends or family who might benefit from our services, and let's help everyone get back to their best selves.
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