Proximal humerus fracture – experiences?

High speed off & snapped the top off my humerus. 2 part fracture pinned back together. French doctors aren’t easy to question on expected recovery, but has anyone had the same & how long did it take to recover? How long to be back riding? I’m mid-thirties, in pretty good shape if its of any relevance.

Well don’t they say it takes six weeks for a broken bone to heal?

Are you in the clinic in Moutiers by any chance? Have the admin staff been up to see you and told you “don’t be in a hurry to leave, stay as long as you need!” while casting a greedy eye over your travel insurance policy?

I had a commutated fracture of the humerus that (according to the consultant on duty) wasn’t suitable for pinning (there was a flake that might detach and was too small to drill…) so they put it in a poly sling for 6-8 weeks. That hurtI can tell you!

I had hydrotherapy after 4 weeks (which was bliss!) for about 4 weeks, but it wasn’t until about 8 weeks before I got normal physio classes. I got discharged after 12-14 weeks (and could start driving again) and it took another couple of months before I even contemplated serious exercise (however by that time it was winter so it was spring before I got going again).

You will have different complications in that you’ve been pinned and the muscles will need to heal too.

I would say 3 months minimum and probably 6-9 before you feel properly able.

And then you might have the ‘better watch I don’t fall off and damage t again…’, I know I did! Still do to some extent… 😳 however that might just be old age.

I still don’t have 100% mobility but it effects my climbing more than cycling (reduced reach by 100-150mm and lost about 5 degrees of movement).

Also found pain on the road due to dropped position (and that my arm set couple degrees off ‘true’). Hopefully, as pinned, that shouldn’t be the case with you. However after a couple of years it wasn’t really noticeable.

For reference, I was about 5 years older than you are now.

Yeah I did something very similar at the start of October 2012 (for the record it was three weeks after my second son was born so I was pretty unpopular for a while).

Mine wasn’t pinned on the basis that the surgery carried a reasonable risk of leaving me with impaired use of my arm. The natural traction of a sling helped to align the bones so while the bone was in three pieces and quite displaced, the consultant felt confident it would heal well without the risks associated with surgery.

Like Metalheart, it took me three months before my arm was out of the sling and I took the advice of the consultant not to ride the bike again for another two months after that. He said the knit was good but the bones had not hardened at that point and any off (it was January by this point so cold and wet) would result in a mess they might not be able to repair. He might have been being melodramatic but he said the worst case scenario in that event was I would lose the use of my arm.

I started riding on the turbo trainer in mid Feb 2013 and went out on the road again mid March and the mountain bike about a month after that. I had a good year on the MTB in 2013 but by end of summer, I had decided that the way I was riding (being competitive within the group) while working was coming at too high a cost (you can see the previous metal work in the picture). I haven’t ridden the MTB this year at all.

My arm still aches now if I am on the bike for more than four hours and it was aching a lot for most of last year if I was on the road bike for more than 90 minutes. I also have impaired reach and the arm just isn’t as strong as it used to be. I could probably train it up to be stronger though.

Physio is really important and painful so stick with it and hope you heal soon.

Are you in the clinic in Moutiers by any chance? Have the admin staff been up to see you and told you “don’t be in a hurry to leave, stay as long as you need!” while casting a greedy eye over your travel insurance policy?

Spent 3 days in bourg, now spending the rest of my hols watching the rest if the group enjoying their trip.

I have a skiing trip booked for January. Am I being too optimistic to think it might be plausible?

I’m not a doctor, but based on my personal experience I would be very surprised if you weren’t up for skiing by January next year. That’s five months, which is how long I was advised to stay off the bike for (bearing in mind that two of those five were ‘in case’ months rather than enforced months).

Couple of months and you’ll be grand if you get some physio follow up and do what they tell you.

5 months Should see you mobile enough but strength will probably be an issue, probably plan on half days (anything else will then be a bonus… ). You’ll probably need to take it easy though.

Does the metalwork need to come out? If so when? That might affect things.

Comment about a couple months and you’ll be grand is bollocks I’m afraid. I only started driving again after 3 and pulling on the handbrake and changing gear (it was my left arm) was bad enough at the start.

I also found physio with nhs was probably okay for the grannies but not for an active person. Not enough ‘hands on’ so I’d recommend going private at the end the three months if you find similar (especially if you want to go skiing).

For reference I found the pain pretty bad for the first week and needed strong painkillers to allow me to sleep more than half an hour at a time. If you are not experiencing this then your recovery might well be quicker…

Wishing you a speedy recovery.

Does the metalwork need to come out? If so when? That might affect things.

French surgeon said to leave it in unless it was causing pain. Very close to a nerve apparently.

Sleep isn’t great but certainly longer than 30 mins. Manage around 3-4 hours. Tramadol helping

Comment about a couple months and you’ll be grand is bollocks I’m afraid.

Comment about a couple of months and they’ll be grand came from a qualified physio who specialises in that sort of thing…. But it is of course bollocks because some random on the internet said it was bollocks.

I also found physio with nhs was probably okay for the grannies but not for an active person. Not enough ‘hands on’ so I’d recommend going private at the end the three months if you find similar (especially if you want to go skiing).

What benefit do you think hands on treatment would have?

What hands on treatment would you suggest? Massage – no evidence that it works, mobilisation – no evidence that it works, range of movement exercises – lots of evidence, strengthening – lots of evidence. Just because something like massage feels good does not make it good. My NHS patients get the same treatment as my elite sports private patients – i.e. the most suitable for their condition.

The random on the internet isn’t random. He actually broke his humerus, as did I, so has first hand experience of what it is like. I agree with him and not the physio. You are most definitely not ‘grand’ after a couple of months. The break is stable and knitted but not hardened to quote the consultant orthopod who looked after me. You have little strength and the break could easily crumble if you fell of your bike or crashed skiing (after a few months that is). That quote came from a consultant not a physio. My money is on the consultant ands my own experience, which, apart from the plates, is identical to the OPs.

Rondo the nerve that you referenced is the one that put the consultants off plating mine. It’s a weird sensation to get nerve damage. Both my collar bone plates (done both sides) left me with numbness for maybe three years each time and it’s never going to be back to how it was before.

Don’t mean any offence wanman but your comment doesn’t tie up with my actual experience (or Geetees either it would appear). However if you’re an expert in this and the OP is indeed grand in two months then brilliant. Iirc personally I’d just finished hydrotherapy (which as I stated previous was bliss, 45 minutes when the arm was fully supported!) at that stage. (If the bone is pinned, does that accelerate recovery?) I was off work for five weeks, I tried back end of the fourth and my boss told me a needed another (and I’ve a desk job). Hence my comment. I’m not a believer in giving false hope. I was still in my sling (albeit not all the time) at 2 months and I was doing what I was being told to do by the physios. Believe me, I wanted to get better! It might well be random, but I thought this was what the op was asking for.

I wholeheartedly take your point about the physio though. I felt it was like ‘you can move your arm about now? Good, our job is done, bye’ at three months. I felt I could’ve done with a months more supervision/direction. I had no complaints up until then.

I ended up having ‘sports/remedial’ massage about a year later. Did it do any real good? Don’t know. I wish I’d had extended physio and if I was in the same situation I’d pursue this (either through the nhs or failing that, private). But thanks for calling me out on this, misinformation is not what the op needs!

ETA: I was only cleared to drive again at the end of 3 months, the physios explicated stated if I tried before then it was illegal! They were right though, I wouldn’t have been safe to do so before that.

The plates do not accelerate the healing process they just align and stabilise the break. You can’t cheat nature.

The biggest cause of negative outcomes in shoulder rehab is immobility in my experience. That immobility tend to be due to fear avoidance behaviour because patients are afraid to move a painful joint, and also because they feel that they need to wait until the bone is healed before they can move their shoulder. The reality is that the bone ends are being held in place by some nice bits of metal and aren’t likely to go very far unless you do something really daft and the best way to get rid of pain is to move the thing. My advice to the OP is to start doing gentle pendular exercises and build them up as pain allows, which is probably what th physios in orthopaedics told you to do.

Metalheart – assuming that you’re in the UK your physio was lying or you’ve misunderstood them. As long as you can operate all of the controls safely and consistently you are ok to drive. There is no set timescale for that.

There are obviously other more complicated cases which involve traumatic nerve palsies and malunion etc, but they’re not all that common.

Okay, my humerus wasn’t plated, consultant was concerned about the stray flake pinging off. When I returned after a week for my first fracture clinic I was asked if I was doing the pendular exercise (I hadn’t, and I explicitly told him this, is that filter avoidance?). Started that at about two weeks though, and progressed to the hydro around four. We are in agreement so far… I think 😉

Re physios, as I stated, I doubt I was safe to operate the vehicle much before the end of three months when they confirmed it was ok. Sounds like they were correct to me I first asked at two months and that when I was told no, physio said, ‘try taking off the handbrake..’ I did, try I mean. (yes, I’m in the UK).

Interesting that the concept of fear avoidance is formally recognised. I definitely experienced that also but was also advised to do some basic exercise in the arm continually during the healing process. The elbow joint in particular ended up being stiff from being held in the crook position for so long.

I think the issue here is, does all grand mean that after two to three months you’ll be back to 100% fitness or just that you’ll be well on your way to that and ready to start using your arm again for regular duties. Sounds like the latter. Maybe not ready to go mountain biking or skiing but ready to drive, wipe your arse, brush your teeth, w……. Let’s not go there though eh.

Broke mine lOctober 13th like second pic. Every case is unique. I was in the ‘Couple of months and you’ll be grand’ camp’. Not saying you’ll be though. My first very tentative ride was 23rd of November. My advice is rest but move. Will post more details of rehab/ recovery later if you like.

Thinking a bit more about this (and a bit of googling…) it should be noted that my break was actually a pretty bad one (as my first post it was commutated, i.e. actually 5 separate breaks) so perhaps my experience is towards the longer recovery end of things. OP is a simpler 2 part separation and being pinned is more stable. My googling suggests a three month recovery period is usual but phunkmasters experience gives some hope I’d say 😀

OP: whatever else the real thing coming out of this is you need to get the arm moving as soon as possible. Certainly after two weeks at the latest I was taking the arm out of the sling and straightening it (mainly by allowing the arm to ‘dangle’, supported by the good arm at the same time) and then by allowing it to ‘swing’ from side to side and in a circle. Obviously it was very minimal movement to start with! This meant the elbow didn’t seize/stiffen up. Don’t worry, the pain feedback loop will quickly tell you if you are pushing it too much too fast. From experience basic mobility is possible relatively quickly so do whatever you are told re. this…

Oh I also got bollocked by a fracture clinic nurse for letting my wrist ‘flop’ out the sling, so try keep it self supported to reduce the amount of muscle wastage.

I presume you are heading back home at the end of the week? I doubt much can be done in the first week anyway (I certainly had that fear thing mentioned above). When you get back to the UK I’d recommend going straight to A&E to get into the system ASAP. I dislocated a finger in the states and I went to see my doc first who then told me the quickest way was A&E. Just remember your medical notes when you attend!

French surgeon has told me not to move the arm at all for the first 4 days, then only “passively” (not under its own strength) for the following 35. This seems at odds with what i’ve read online about when physio begins, but i’ll wait until i’ve seen an actual expert before doing anything differently.

Changed the stapling dressing last night; worst tan lines ever.

edit: Earliest appointment with GP is next thursday. Another in our group has recommended going to a minor injuries clinic, who will be unable to treat it, but will refer me to a fracture specialist asap. r/e the notes, hopefully they can read french!

French surgeon has told me not to move the arm at all for the first 4 days, then only “passively” (not under its own strength) for the following 35.

That is exactly what I was told by the consultants in the UK.

Late 30s, active/fit. Mine was a bad break, shoulder only but not the ‘knocking an ice cream off a cone’ type. More like taking a slice out of cake. No pins or operation but my bones were in a good place.

Obviously, at first, I kept it as still possible because every time I raised my arm sideways the muscle attached would separate the bone like a flip top bin lid. That stung a little bit. Six weeks of minimal movement but dangling arm if/when possible to avoid frozen shoulder.

I kept as active as possible against they doctor’s wishes. I don’t recommend that but I’ve always been a pain in the butt. Funnily enough I did nearly fall of a stationary bike.

What hurt the most after the initial six weeks was situations when my muscles reacted fast and instinctively. Like nearly knocking something off a table and going to catch it. The worst was an slight shock from a light switch that made me flinch.

I was lucky I guess because the range of movement needed for cycling was fine. Crashing is another story though and perhaps I should have given it more time before riding.

My advice is avoid the internet (I see the irony here) take time and ease back in. Do the rehab even if it seems pointless, I struggled with it more because it was hard work. I ate well, nothing fancy/no supplements because of all the conflicting advice. I still do a fair bit on resistance bands and standard compound exercises. My strength is now fine and my range of movement not noticeably different apart from reaching around my back.

Hope you’re good soon.

i’ll wait until i’ve seen an actual expert before doing anything differently.

This is definitely the best course of action! We’re just some internet randoms anyway… 😉

Tbh, it was two weeks (and after I’d stopped taking the strong painkillers) before I could bring myself to try anything! Pain and fear of more of it does not make you want to try sooner…

The exercises I did were using the weight of the arm itself, so all passive. You kind of use the body to move round the arm… Hydrotherapy probably started around the 35 days point (and the water supports the arm).

I still think heading to A&E is best, after all it’s the fracture clinic you need to ‘register’ with and A&E is where that (and the x-Ray dept. is situated). Go early week day morning and be prepared to wait as you are not an emergency (so just about everybody else will be of higher importance at triage I’m afraid…). I was told by my GP that a letter from him would take 2-3 weeks to get a response (which is obviously too long for you as it was for me). You need to get into the hospital system ASAP for everything else to be lined up for you.

What hurt the most after the initial six weeks was situations when my muscles reacted fast and instinctively

Oh, I did this about two weeks in. I was dosing in front of the TV/DVD and the remote started to fall off my knee… I instinctively went to grab it… with by broken arm…. Ouch! I think there might actually have been a few tears it hurt so much.

my wife got a superman fracture which was a really small crack – 8 weeks before she was really better and she still gets a bit of pain sometimes. lot of issues come from tendon damage in that area. a massive break like that is going to take a while to heal. only thing you can do is eat properly, rest and do the correct physio. give up on thinking how long as everybody is different.