Broken arm

Overview

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 might 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 keep the bone in place during healing.

Symptoms

A snap or cracking sound might be your first indication you've broken an arm. Signs and symptoms include:

• Severe pain, which might 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. The same applies to 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.

Causes

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 cause 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 might be the result of child abuse.

Risk factors

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

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

Conditions that weaken bones, such as osteoporosis and bone tumors, increase your risk of a broken arm. This type of break is known as a pathological fracture.

Complications

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

• Uneven growth. Because a child's arm bones are still growing, a fracture in the area where growth occurs near each end of a long bone (growth plate) can interfere with that bone's 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 a part of your broken bone protrudes through your skin, it can 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 can injure nearby nerves and blood vessels. Seek immediate medical attention if you notice 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.

Prevention

Although it's impossible to prevent an accident, these tips might offer some protection against bone breakage.

• 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; from fortified foods, such as milk and orange juice; and from sun exposure.
• Exercise for bone strength. Weight-bearing physical activity and exercises that improve balance and posture can strengthen 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. To prevent falling, wear sensible shoes. Remove home hazards that can cause you to trip, such as area rugs. Make sure your living space is well lit. Install grab bars in your bathroom and handrails on your stairways, if necessary.
• Use protective gear. Wear wrist guards for high-risk activities, such as in-line skating, snowboarding, rugby and football.
• Don't smoke. Smoking can increase your risk of a broken arm by reducing bone mass. It also hampers healing of fractures.

Diagnosis

Your doctor will examine your arm for tenderness, swelling, deformity or an open wound. After discussing your symptoms and how you injured yourself, your doctor likely will order X-rays to determine the location and extent of the break. Occasionally, another scan, such as an MRI, might be used to get more-detailed images.

Treatment

Treatment of a broken arm depends 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; and tobacco and alcohol use.

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. Surgery might be required to realign the fragments.
• Comminuted fracture. The bone is broken into pieces, so it might require surgery.
• Greenstick fracture. The bone cracks but doesn't break all the way — like what happens when you bend a green stick of wood. Most broken bones in children are greenstick fractures because children's bones are softer and more flexible than are those of adults.
• 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 might need to move the pieces back into position (reduction). Depending on the amount of pain and swelling you have, you might need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization

Restricting movement of a broken bone, which requires a splint, sling, brace or cast, is critical to healing. Before applying 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 might ask you to return for X-rays during the healing process to make sure the bones haven't shifted.

Medications

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

Nonsteroidal anti-inflammatory drugs can help with pain but might also hamper bone healing, especially if used long term. Ask your doctor if you can take them for pain relief.

If you have an open fracture, in which you have a wound or break in the skin near the wound site, you'll likely be given an antibiotic to prevent infection that could reach the bone.

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 might 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 might 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 — might be needed to hold your bones in place during healing. Complications are rare, but can include infection and lack of bone healing.

Preparing for an appointment

Depending on the severity of the break, your family doctor or the emergency room physician might refer you or your child to a doctor who specializes in injuries of the body's musculoskeletal system (orthopedic surgeon).

What you can do

Make a list that includes:

• Details about your or your child's symptoms and the incident that caused them
• Information about past medical problems
• All the medications and dietary supplements you or your child takes
• Questions to ask the doctor

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

• What tests are needed?
• What is the best course of action?
• Is surgery necessary?
• What restrictions will need to be followed?
• Do you recommend seeing a specialist?
• What pain medications do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

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