Broken arm

A broken arm involves one or more of the three bones in your arm — the ulna, radius and humerus. One of the most common causes of a broken arm is falling onto an outstretched hand. If you think you or your child has broken an arm, seek prompt medical attention. It’s important to treat a fracture as soon as possible for proper healing.

Treatment depends on the site and severity of the injury. A simple break may be treated with a sling, ice and rest. However, the bone may require realignment (reduction) in the emergency room.

A more complicated break might require surgery to realign the broken bone and to implant wires, plates, nails or screws to maintain proper alignment during healing.

An audible snap or cracking sound may be your first indication you’ve broken an arm. Signs and symptoms include:

• Severe pain, which may increase with movement
• Swelling
• Bruising
• Deformity, such as a bent arm or wrist
• Inability to turn your arm from palm up to palm down or vice versa

When to see a doctor

If you have enough pain in your arm that you can’t use it normally, see a doctor right away. And do the same for your child. Delays in diagnosis and treatment of a broken arm, especially for children who heal faster than adults do, can lead to poor healing.

Common causes for a broken arm include:

• Falls. Falling onto an outstretched hand or elbow is the most common cause of a broken arm.
• Sports injuries. Direct blows and injuries on the field or court are a common cause of all types of arm fractures.
• Significant trauma. Any of your arm bones can break during a car accident, bike accident or other direct trauma.
• Child abuse. In children, a broken arm may be the result of child abuse.

Certain medical conditions or physical activities can increase the risk of a broken arm.

Participation in certain sports

Any sport that involves physical contact or increases your risk of falling — including football, soccer, gymnastics, skiing and skateboarding — also increases the risk of a broken arm.

Bone abnormalities

People with conditions that weaken bones, such as osteoporosis and bone tumors, are at higher risk of a broken arm. This type of break is known as a pathological fracture.

The prognosis for most arm fractures is very good if treated early. But complications may include:

• Uneven growth. Because a child’s arm bones are still growing, a fracture in a growth plate — the area where growth occurs near each end of a long bone — can interfere with that bone’s normal growth.
• Osteoarthritis. Fractures that extend into a joint can cause arthritis there years later.
• Stiffness. The immobilization required to heal a fracture in the upper arm bone can sometimes result in painfully limited range of motion of the elbow or shoulder.
• Bone infection. If any part of your broken bone protrudes through your skin, it may be exposed to germs that can cause infection. Prompt treatment of this type of fracture is critical.
• Nerve or blood vessel injury. If the upper arm bone (humerus) fractures into two or more pieces, the jagged ends may injure nearby nerves and blood vessels. Seek immediate medical attention if you notice any numbness or circulation problems.
• Compartment syndrome. Excessive swelling of the injured arm can cut off the blood supply to part of the arm, causing pain and numbness. Typically occurring 24 to 48 hours after the injury, compartment syndrome is a medical emergency that requires surgery. It can also be caused by a too-tight cast.

Depending on the severity of the break, your family doctor or the emergency room physician may recommend that an orthopedic surgeon examine you or your child.

What you can do

You may want to write a list that includes:

• Detailed descriptions of the symptoms and the precipitating event
• Information about past medical problems
• All the medications and dietary supplements you or your child takes
• Questions you want to ask the doctor

For a broken arm, basic questions to ask your doctor include:

• What tests are needed?
• What is the best course of action?
• Is surgery necessary?
• What are the alternatives to the primary approach you’re suggesting?
• What restrictions will need to be followed?
• Should I see a specialist?
• What pain medications do you recommend?

Don’t hesitate to ask any other questions you have.

What to expect from your doctor

During the physical exam, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound. He or she will probably want to see X-rays of the injury.

Your doctor is likely to ask you questions, including:

• Did the symptoms come on suddenly?
• What caused the symptoms?
• Did you or your child experience an injury to trigger the symptoms?
• How severe are the symptoms?
• What, if anything, seems to improve the symptoms?
• What, if anything, appears to worsen the symptoms?

After discussing your symptoms and how you injured yourself and examining your arm, your doctor is likely to order X-rays to determine the extent of a fracture and injury to adjacent joints and pinpoint the location of the break. Occasionally, your doctor may also recommend another scan such as an MRI to obtain more-detailed images.

Treatment of a broken arm will vary, depending on the type of break. The time needed for healing depends on a variety of factors, including severity of the injury; other conditions, such as diabetes; your age; nutrition; tobacco use and excessive use of alcohol.

Fractures are classified into one or more of the following categories:

• Open (compound) fracture. The broken bone pierces the skin, a serious condition that requires immediate, aggressive treatment to decrease the risk of infection.
• Closed fracture. The skin remains unbroken.
• Displaced fracture. The bone fragments on each side of the break aren’t aligned, which may require surgery to realign the bones.
• Comminuted fracture. The bone is broken into pieces, which may require surgery for complete healing.
• Greenstick fracture. The bone cracks but doesn’t break all the way through — like what happens when you try to break a green stick of wood. Most broken bones in children are greenstick fractures, because a child’s bones are softer and more flexible than are those of an adult.
• Buckle (torus) fracture. One side of the bone is compressed, which causes the other side to bend (buckle). This type of fracture is also more common in children.

Setting the bone

If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization

Restricting movement of a broken bone is critical to healing. To do this, you may need to wear a splint, sling, brace or cast. If your broken arm requires a cast, your doctor will likely wait until the swelling goes down, usually five to seven days after injury. In the meantime, you’ll likely wear a splint.

Your doctor may ask you to return for more X-rays during the healing process to make sure the bones haven’t shifted.

Medications

To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever. If you’re experiencing severe pain, you may need to take a prescription medication that contains a narcotic for a few days.

Therapy

Rehabilitation begins soon after initial treatment. In most cases, it’s important, if possible, to begin some motion to minimize stiffness in your arm, hand and shoulder while you’re wearing your cast or sling. After your cast or sling is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to restore muscle strength, joint motion and flexibility.

Surgery

Surgery is required to stabilize some fractures. If the fracture didn’t break the skin, your doctor may wait to do surgery until the swelling has gone down. Keeping your arm from moving and elevating it will decrease swelling.

Fixation devices — such as wires, plates, nails or screws — may be needed to maintain proper position of your bones during healing. Complications are rare, but can include infection and lack of bone healing.

A broken arm usually happens in an unplanned, unexpected instant. Although it’s impossible to foresee or prevent that instant, these basic tips may offer some protection.

• Eat for bone strength. Eat a healthy diet that includes calcium-rich foods, such as milk, yogurt and cheese, and vitamin D, which helps your body absorb calcium. You can get vitamin D from fatty fish, such as salmon; fortified foods, such as milk and orange juice; and from sun exposure. Talk to your doctor about how much calcium and vitamin D you need.
• Exercise for bone strength. Weight-bearing physical activity and exercises that improve balance and posture can strengthens bones and reduce the chance of a fracture. The more active and fit you are as you age, the less likely you are to fall and break a bone.
• Prevent falls. Falling forward onto an outstretched hand is the leading cause of a broken arm. To prevent this common injury, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.
• Use protective gear. Wear wrist guards for high-risk activities, such asin-line skating, snowboarding, rugby and football.

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