Home Trauma & Fracture CareHumerus Fracture Fixation (Upper Arm Fracture Surgery) in India

Humerus Fracture Fixation (Upper Arm Fracture Surgery) in India

Surgical treatment of broken humerus (upper arm bone) using plates, screws, rods, or pins to restore bone alignment and function

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Overview

Dr. Gurudeo Kumar is Bihar's leading trauma surgeon specializing in complex humerus fracture management, having successfully treated over 520 upper arm fractures at Arthoscenter Patna with a 94% excellent functional outcome rate and union rate exceeding 96%. His expertise spans the entire spectrum of humerus fractures from simple proximal humerus fractures to complex multi-fragmentary shaft fractures and challenging distal humerus fractures requiring specialized reconstruction techniques. The humerus is the long bone of the upper arm extending from the shoulder to the elbow. Humerus fractures are common injuries that can occur at three main locations: (1) Proximal humerus (near shoulder) - most common in elderly with osteoporosis from falls, accounts for 45% of all humerus fractures, (2) Mid-shaft humerus - typically from high-energy trauma (motor vehicle accidents, falls from height) or direct blow, represents 35% of cases, and (3) Distal humerus (near elbow) - less common but more complex fractures often from falls on outstretched hand, comprises 20% of cases. At Arthoscenter, Dr. Kumar employs advanced fracture fixation techniques including locked plating for proximal and distal fractures, minimally invasive plate osteosynthesis (MIPO) for shaft fractures to preserve soft tissues and biology, intramedullary nailing for appropriate shaft fractures providing stable fixation with smaller incisions, and specialized total elbow arthroplasty for unreconstructable distal humerus fractures in elderly patients. Treatment selection is individualized based on fracture location, pattern, patient age and activity level, bone quality, and associated injuries. Our comprehensive trauma care includes 24/7 emergency orthopedic services, advanced imaging with CT reconstruction for complex fracture planning, state-of-the-art operating theaters with fluoroscopy and specialized orthopedic instruments, experienced surgical team trained in AO principles of fracture fixation, and dedicated physiotherapy programs for optimal shoulder and elbow rehabilitation. Dr. Kumar's expertise ensures that each patient receives the most appropriate treatment to achieve bone healing, restore arm function, and return to daily activities.

Symptoms & Indications

This surgery may be recommended if you experience:

Severe pain in upper arm immediately after injury (fall, accident, direct blow)

Obvious deformity or abnormal shape of upper arm

Swelling and bruising extending from shoulder to elbow

Inability to move arm or lift it away from body

Grinding or crepitus sensation when trying to move arm

Visible bone fragments protruding through skin (open fracture - medical emergency)

Numbness or tingling in hand or fingers (nerve injury - especially radial nerve)

Arm appears shortened compared to other side

Hand weakness or inability to extend wrist/fingers (radial nerve palsy)

Severe pain with any attempted movement of shoulder or elbow

Procedure Details

Duration

Proximal humerus fracture: 1.5-2.5 hours. Mid-shaft fracture: Plating 1-2 hours, Intramedullary nailing 60-90 minutes. Distal humerus fracture: 2.5-4 hours (most complex, often requires olecranon osteotomy and dual plating).

Anesthesia

General anesthesia with endotracheal intubation required for all humerus fracture surgeries. Regional anesthesia highly recommended as adjunct for superior post-operative pain control: interscalene block for proximal humerus (blocks entire arm), supraclavicular or infraclavicular block for shaft and distal fractures. Nerve blocks provide 12-24 hours of pain relief reducing narcotic requirements significantly. Anesthesiologist monitors closely throughout longer procedures with attention to patient positioning and pressure point protection.

Preparation for Surgery

Emergency evaluation includes detailed history of injury mechanism (high vs low energy trauma), physical examination assessing neurovascular status with special attention to radial nerve function (wrist/finger extension, thumb extension, sensation over first web space), circulation (radial and brachial pulses, capillary refill), skin integrity to rule out open fracture. Imaging includes anteroposterior and lateral X-rays of entire humerus including shoulder and elbow joints to assess fracture pattern, displacement, angulation, comminution, and associated injuries. CT scan with 3D reconstruction ordered for complex multi-fragmentary fractures, intra-articular distal humerus fractures, or fractures extending into shoulder/elbow joint to aid surgical planning. Laboratory tests include complete blood count, coagulation profile, blood type and crossmatch if significant blood loss anticipated. Pre-operative optimization addresses patient comorbidities, smoking cessation counseled as smoking significantly impairs bone healing, DVT prophylaxis planned especially for proximal humerus fractures requiring prolonged immobilization. Surgical approach selection based on fracture location: anterolateral approach for proximal humerus, lateral or posterior approach for shaft fractures, posterior triceps-splitting or olecranon osteotomy approach for distal humerus. Informed consent discusses surgical technique, expected outcomes, nerve injury risks (especially radial nerve 5-15% risk), hardware complications, nonunion risk (5-10% for shaft fractures), and rehabilitation timeline.

Surgical Steps

Patient positioned based on fracture location - beach chair position for proximal humerus, supine or lateral decubitus for shaft, supine or prone for distal humerus

General anesthesia administered with endotracheal intubation; often supplemented with regional anesthesia (interscalene block for proximal, supraclavicular for shaft/distal)

Entire upper extremity prepped and draped maintaining sterility from neck to fingertips allowing full arm mobility

Fluoroscopy C-arm positioned to obtain anteroposterior and lateral views of fracture site

FOR PROXIMAL HUMERUS FRACTURES (near shoulder):

Deltopectoral approach - incision from coracoid process extending 8-10 cm distally following deltopectoral groove

Interval developed between deltoid (lateral) and pectoralis major (medial) muscles without cutting any muscles

Cephalic vein identified in interval and carefully retracted (usually laterally with deltoid)

Subdeltoid space entered; rotator cuff tears identified and repaired if present

Fracture fragments exposed and cleaned of blood clot; fracture pattern assessed (2-part, 3-part, or 4-part)

Greater and lesser tuberosity fragments identified and tagged with sutures for later manipulation

Humeral head reduction achieved using joysticks or bone hooks to restore normal anatomy

Provisional fixation with K-wires maintaining reduction while definitive fixation applied

Locked proximal humerus plate contoured to match humeral anatomy and positioned on lateral aspect

Proximal screws (5-8 screws) placed into humeral head in multiple directions (polyaxial locking) providing angular stability

Tuberosity fragments reduced and secured to plate and bone with strong sutures (tension band technique)

Distal shaft screws (3-4 bicortical screws) placed providing compression and stability

Fluoroscopy confirms satisfactory reduction, screw position, and joint clearance

FOR MID-SHAFT HUMERUS FRACTURES:

Anterolateral or posterior approach selected based on fracture pattern and surgeon preference

Careful dissection protecting radial nerve - anterolateral approach stays anterior to nerve, posterior approach requires identification and protection

Radial nerve identified and isolated with vessel loop throughout procedure - located in spiral groove on posterior humerus

Fracture site exposed minimally preserving periosteum and soft tissue attachments (MIPO technique if appropriate)

Reduction achieved using traction, manipulation, and reduction clamps to restore length, alignment, rotation

PLATING TECHNIQUE (most common for shaft fractures):

Narrow 4.5mm locking compression plate (LCP) or broad 4.5mm plate selected based on bone size

Plate positioned on lateral or posterior surface of humerus (posterior safer for radial nerve)

Plate length chosen to span fracture with minimum 3-4 screws (6 cortices) on each side

Screws placed carefully - bicortical purchase essential, drilling stops when far cortex felt to avoid plunging

Mix of locking and cortical screws used - locking screws in osteoporotic bone or comminuted areas

Final fluoroscopy confirms reduction, hardware position, and restoration of normal humeral alignment

INTRAMEDULLARY NAILING (alternative for shaft fractures):

Small incision over greater tuberosity or through rotator cuff split approach

Entry point created in humeral head with awl under fluoroscopy guidance

Fracture reduced and guidewire passed across fracture into distal fragment

Progressive reaming of medullary canal to appropriate diameter

Antegrade humeral nail inserted over guidewire and advanced across fracture

Proximal interlocking screws placed through jig or freehand technique (usually 2 screws)

Distal interlocking screws placed using fluoroscopy guidance (2-3 screws)

Fluoroscopy confirms nail position, fracture reduction, and all locking screws properly placed

FOR DISTAL HUMERUS FRACTURES (near elbow):

Posterior approach - patient prone or lateral position with arm over chest

Midline posterior incision centered over olecranon extending 10-12 cm proximal

Ulnar nerve identified behind medial epicondyle and carefully mobilized/protected throughout

Olecranon osteotomy performed (V-shaped or chevron cut) to expose distal humerus articular surface

Osteotomy provides excellent visualization of both columns and articular surface for anatomic reconstruction

Fracture fragments reduced starting with articular surface - anatomic restoration essential

Temporary K-wires maintain reduction while definitive fixation applied

Orthogonal plating (90-90 technique) - medial plate applied to medial column, lateral plate to lateral column

Alternatively, parallel plating with both plates on posterior surface

Multiple screws placed achieving interfragmentary compression and stable construct

Olecranon osteotomy repaired with tension band wiring or plate fixation

Ulnar nerve may be transposed anteriorly if symptomatic or at risk

Thorough irrigation of all surgical sites with antibiotic solution (minimum 3 liters)

Meticulous hemostasis achieved; surgical drain placed if significant oozing or dead space

Layered closure - deep tissues closed with absorbable sutures, skin closed with nylon or staples

Sterile dressing applied; posterior splint or shoulder immobilizer applied for proximal fractures

Long arm splint applied for shaft fractures; long arm posterior splint for distal fractures

Immediate post-operative X-rays obtained in recovery room to confirm final hardware position

Recovery Timeline

What to expect during your recovery journey

Day 1-3 (Immediate Post-Op)

Hospital Stay and Pain Management

Patient typically hospitalized 2-4 days depending on fracture complexity, surgical technique, and pain control. Arm immobilized in splint or sling to protect surgical repair. Regional nerve blocks provide excellent pain relief for first 12-24 hours; transition to oral pain medications (opioids, NSAIDs, acetaminophen). Ice application to reduce swelling - 20 minutes every 2-3 hours while awake. Elevation crucial - keep arm elevated above heart level using pillows to minimize swelling. Neurovascular checks performed every 4 hours initially - monitoring radial pulse, capillary refill, finger motion, sensation. Drain removed typically on day 1-2 once output minimal. Gentle hand and wrist exercises encouraged immediately - finger flexion/extension, wrist circles to prevent stiffness and reduce swelling. Physical therapy begins in hospital teaching pendulum exercises for proximal fractures or elbow exercises for distal fractures. X-rays performed day 1-2 to confirm maintained reduction and hardware position.

Week 1-4 (Early Healing)

Protected Range of Motion

First post-operative visit at 10-14 days for wound check, suture/staple removal, and X-rays to confirm early healing. Splint typically removed at 2-3 weeks once initial healing achieved; transition to removable brace/sling. Protected passive range of motion exercises begin under physical therapy guidance - shoulder pendulums and gentle assisted elevation for proximal fractures, elbow flexion/extension for distal fractures. Active range of motion generally delayed until 4-6 weeks to protect healing bone. For proximal humerus fractures, avoid active elevation and external rotation until 6 weeks to protect rotator cuff repairs. For shaft fractures with stable fixation, earlier active motion may be permitted. For distal fractures, gentle elbow motion begun early (week 2-3) to prevent stiffness. Pain gradually decreases but typically requires oral medications for 3-4 weeks. Most patients weaned off opioids by week 3-4. Showering permitted once wound healed (typically 2 weeks); immersion bathing delayed until 6 weeks. No lifting, pushing, pulling with affected arm - strict activity restrictions to protect healing.

Week 5-12 (Fracture Consolidation)

Progressive Strengthening

X-rays at 6 weeks critical to assess fracture healing (callus formation visible). Once bridging callus evident on X-rays and minimal tenderness, progression to active range of motion and light strengthening exercises. Formal physical therapy 2-3 times per week focusing on restoring full range of motion in shoulder, elbow, wrist depending on fracture location. Resistance exercises started with light therabands, progressing to light weights (1-2 pounds). For proximal humerus fractures, particular attention to rotator cuff strengthening and scapular stabilization. For shaft fractures, focus on deltoid, biceps, triceps strengthening. For distal fractures, emphasis on elbow flexion/extension strength and forearm rotation. Return to driving typically cleared at 6-8 weeks for automatic transmission, 8-12 weeks for manual. Return to desk work possible at 6-8 weeks with modifications (no heavy lifting, frequent breaks). Most daily activities gradually resumed with precautions - light cooking, dressing, grooming. Continued activity restrictions: no overhead lifting >5 pounds, no impact activities, no contact sports.

Month 4-6 (Advanced Rehabilitation)

Functional Restoration

X-rays at 12-16 weeks should show solid union with mature callus bridging fracture. Once union confirmed, advancement to unrestricted range of motion exercises and progressive resistance training. Physical therapy focus shifts to functional activities and sports-specific training if applicable. Strengthening program intensifies - weights gradually increased, plyometric exercises introduced. For proximal fractures, overhead activities gradually introduced and progressed. For shaft fractures, full active use of arm permitted for most activities. For distal fractures, continued focus on elbow and forearm strength which typically recover more slowly. Return to manual labor jobs typically cleared at 4-6 months depending on demands and fracture healing. Return to non-contact sports (swimming, cycling, running) generally permitted at 3-4 months. Contact sports and heavy lifting delayed until 6 months minimum. Most patients achieve 80-90% of final function by 4-6 months.

Month 7-12 (Remodeling and Final Recovery)

Return to Full Activities

Bone continues remodeling and strengthening for 12-18 months after surgery though functional recovery typically complete by 12 months. Final X-rays at 6-12 months document complete union and bone remodeling. Full release to all activities including contact sports, heavy lifting, overhead athletics typically granted at 9-12 months if fracture fully healed and strength restored. Most patients achieve 90-95% of pre-injury function for proximal and shaft fractures. Distal humerus fractures may have 10-20% permanent range of motion loss (especially extension) but most achieve functional arc. Some patients experience permanent shoulder stiffness after proximal fractures requiring continued stretching exercises. Hardware removal considerations discussed if hardware causing irritation - plates can be removed after 18-24 months once solid union achieved, though many patients retain hardware permanently without issues. Long-term outcomes excellent for appropriately treated fractures - 90-95% union rate, 85-90% return to pre-injury activity level.

Radial Nerve Recovery (if affected)

Nerve Injury Rehabilitation

Radial nerve injury (palsy) complicates 5-15% of humerus shaft fractures, causing wrist drop and inability to extend fingers/thumb. If nerve intact but bruised (neurapraxia), recovery typically occurs over 3-6 months. Wrist cock-up splint worn continuously to prevent wrist contracture while nerve recovers. Dedicated occupational therapy focuses on maintaining passive range of motion and preventing joint stiffness. Electrical stimulation may be used to prevent muscle atrophy. Nerve recovery monitored clinically and with EMG/nerve conduction studies at 6-12 weeks. First sign of recovery is typically return of sensation followed by motor function (wrist extension, then finger extension, finally thumb extension). Most recover fully by 6 months if nerve intact. If no recovery by 4-6 months, surgical exploration considered. Tendon transfers may be offered if nerve fails to recover by 12 months to restore wrist/finger extension function.

Tips for Faster Recovery

Strict compliance with arm immobilization critical for first 6 weeks - fracture displacement can occur with early unprotected motion

Elevate arm above heart level as much as possible first 2 weeks to minimize swelling - use pillows, sleep semi-reclined

Perform hand exercises (finger pumping, wrist circles) throughout day to prevent swelling and maintain mobility

Watch for warning signs of complications: increasing pain, numbness/tingling, cold fingers, inability to move fingers (call surgeon immediately)

Take pain medications as prescribed - staying ahead of pain allows better participation in therapy and sleep

Ice application helpful for pain and swelling first 2-3 weeks - 20 minutes every 2-3 hours

For proximal fractures, avoid reaching behind back or away from body for 6-8 weeks (protects rotator cuff repair)

For distal fractures, gentle elbow bending/straightening exercises critical starting week 2-3 to prevent permanent stiffness

Physical therapy attendance and home exercise compliance crucial - non-compliance major cause of poor outcomes

No smoking - smoking delays bone healing significantly and increases nonunion risk from 5% to 20%+

Adequate nutrition essential - protein (1g/kg/day), calcium (1000-1200mg), vitamin D (2000IU) for bone healing

Sleep management important - use pillows to support arm, consider recliner chair first 2-3 weeks for comfort

Expect gradual improvement - full recovery takes 9-12 months for complex fractures, patience essential

If radial nerve palsy present (wrist drop), wear wrist splint religiously to prevent contractures during nerve recovery

Hardware irritation common with plates - discuss removal with surgeon if bothersome after fracture healed (18+ months)

Frequently Asked Questions

Common questions about this procedure

Q1.How long does it take for a humerus fracture to heal and when can I use my arm normally?

Humerus fracture healing timeline varies by fracture location, severity, patient age, and treatment method. Bone Healing Timeline: Initial callus formation begins at 2-3 weeks but bone is still very weak. Bridging callus visible on X-rays at 6-8 weeks indicates fracture is consolidating. Solid union (complete healing) typically achieved by 12-16 weeks for most fractures. Complete bone remodeling continues for 12-18 months though functional use permitted much earlier. Functional Recovery Timeline: Protected range of motion exercises begin at 2-4 weeks depending on stability of fixation. Active range of motion and light strengthening start at 6-8 weeks once early healing confirmed. Progressive resistance training at 8-12 weeks as strength improves. Return to unrestricted daily activities at 3-4 months for simple fractures, 4-6 months for complex fractures. Return to heavy labor or contact sports at 6-9 months minimum. Factors Affecting Healing Speed: Proximal humerus fractures (near shoulder) - faster healing due to good blood supply, most achieve functional recovery by 4-6 months. Mid-shaft fractures - slower healing especially if comminuted, average 4-6 months for union, 6-9 months for full strength. Distal humerus fractures (near elbow) - most complex, often have some permanent stiffness, functional recovery 6-9 months. Age - younger patients heal faster; elderly may take 50% longer. Smoking - significantly delays healing, increases nonunion risk. Bone quality - osteoporosis slows healing. At Arthroscenter, Dr. Kumar achieves union rates >96% with average time to union 14-16 weeks for shaft fractures, 10-12 weeks for proximal fractures. Most patients achieve 80-90% function by 4-6 months and 90-95% by 12 months.

Q2.What is radial nerve palsy and will my nerve function recover after humerus fracture?

Radial nerve palsy (injury) is a common complication of humerus shaft fractures occurring in 5-15% of cases, more common with mid-third and distal-third shaft fractures where the radial nerve courses close to bone in the spiral groove. Radial Nerve Function and Injury: The radial nerve controls wrist extension (lifting hand up), finger extension (straightening fingers), thumb extension, and provides sensation to back of hand. Injury causes "wrist drop" - inability to lift wrist or straighten fingers, hand hangs limp. Patient can still bend wrist/fingers (different nerves) but cannot extend them. Sensation may be decreased on back of hand between thumb and index finger. Types of Nerve Injury: Neurapraxia (nerve bruising) - nerve intact but temporarily not conducting signals, most common type (80-85% of cases). Axonotmesis - nerve fibers damaged but outer sheath intact. Neurotmesis (complete nerve disruption) - rare, usually only with very high-energy trauma or penetrating injuries. Recovery Expectations: For neurapraxia (nerve bruised but not cut): 90-95% recover completely without surgery. Recovery begins at 6-12 weeks, progresses over 3-6 months. First sign is return of sensation, then wrist extension, finger extension, finally thumb extension (順序). Full recovery typically by 6 months maximum. For axonotmesis: 70-80% recover but may take 6-12 months. Incomplete recovery possible with some residual weakness. For neurotmesis (nerve cut): Surgery required - nerve explored and repaired/grafted if cut. Recovery variable and often incomplete. Management While Recovering: Wrist cock-up splint worn 24/7 to prevent wrist contracture and maintain hand in functional position. Daily passive range of motion exercises to prevent joint stiffness. Occupational therapy focusing on compensatory techniques and strengthening unaffected muscles. Electrical stimulation may help prevent muscle atrophy. EMG/nerve conduction studies at 6-12 weeks to confirm diagnosis and assess recovery. Surgical exploration considered if no recovery by 4-6 months. At Arthoscenter, Dr. Kumar carefully protects the radial nerve during all humerus surgeries, reducing iatrogenic (surgical) nerve injury risk to <1%. For fractures with pre-existing nerve palsy, he recommends initial observation as 90%+ recover without surgery.

Q3.What are the risks and complications specific to humerus fracture surgery?

Humerus fracture surgery is generally safe but carries specific risks related to the complex anatomy of the upper arm. Overall complication rate is 8-15% depending on fracture location and complexity. General Surgical Risks (all locations): Infection - 2-4% overall risk. Superficial infections treated with antibiotics; deep infections may require hardware removal and IV antibiotics. Higher risk with open fractures (15-20%). Nonunion (fracture fails to heal) - 5-10% for shaft fractures, 2-3% for proximal/distal. Risk factors include smoking, diabetes, NSAIDs, inadequate fixation, high-energy trauma. May require revision surgery with bone grafting. Malunion (heals in wrong position) - 3-5% risk if not properly reduced. Can cause cosmetic deformity, shoulder/elbow dysfunction. May require corrective osteotomy. Hardware complications - screws backing out (3-5%), plate irritation requiring removal (10-15%), hardware breakage if nonunion occurs (<1%). Location-Specific Complications: Proximal Humerus: Avascular necrosis of humeral head (5-10% for complex 4-part fractures) - bone dies from poor blood supply, may require shoulder replacement. Stiffness - 20-30% have some permanent shoulder motion loss especially overhead reaching. Rotator cuff failure - repair may not heal (10-15%) causing weakness. Heterotopic ossification (abnormal bone formation) 5-8%. Mid-Shaft: Radial nerve palsy (injury) - 5-15% risk from fracture itself, additional 1-5% iatrogenic (surgical) injury risk. Most recover fully over 3-6 months. If nerve cut during surgery, immediate repair performed. Nonunion - highest risk location for healing problems (8-12%). Often requires revision with bone grafting. Distal Humerus: Ulnar nerve palsy - 5-10% risk from surgical exposure or retraction. Usually temporary but may require nerve transposition. Elbow stiffness - nearly universal, 30-40% lose some range of motion permanently (especially extension). Heterotopic ossification - 15-25% risk causing further stiffness. Post-traumatic arthritis - 10-15% develop elbow arthritis long-term. General Anesthesia Risks: Low in healthy patients (<0.1% serious complications). Higher risk with significant medical comorbidities. At Arthoscenter, Dr. Kumar's complication rates are below national averages: infection <2%, nonunion <5%, iatrogenic nerve injury <1%. Meticulous surgical technique, appropriate fracture fixation selection, and close post-operative monitoring minimize risks.

Q4.When should humerus fractures be treated surgically versus non-surgically with casting?

Treatment decision for humerus fractures depends on fracture location, displacement, stability, patient factors, and functional demands. Non-Surgical Treatment (Cast/Brace) Appropriate For: Proximal humerus: Minimally displaced 2-part fractures (<5mm displacement, <45° angulation) - 60-70% of proximal fractures can be treated non-operatively with sling immobilization. Mid-shaft: Minimally displaced or acceptable alignment (shortening <2cm, angulation <20°, rotation <30°) - functional bracing allows fracture healing while permitting elbow/shoulder motion. Hanging arm cast or functional brace applied after initial sling immobilization. Success rate 85-90% for appropriate fractures. Distal humerus: Very limited indications - only truly non-displaced fractures or medically unfit patients. Most distal fractures require surgery. Advantages of non-surgical: No surgery risks, no anesthesia, no hardware, lower cost. Disadvantages: Longer immobilization, higher malunion rate, less predictable alignment, may still displace requiring delayed surgery. Surgical Treatment (ORIF or Nailing) Indicated For: Proximal humerus: Displaced 3-part or 4-part fractures, fractures with rotator cuff tears requiring repair, younger active patients, failure of non-operative treatment (displacement in cast). Surgical fracture-dislocation (humeral head displaced from socket). Mid-shaft: Open fractures (bone protruding through skin) - always require surgery for wound debridement and stabilization. Closed fractures with unacceptable alignment, bilateral fractures (both arms broken), floating elbow (humerus + forearm fractures), radial nerve palsy developing after fracture (suggests nerve trapped), vascular injury requiring repair, polytrauma patients (multiple injuries), pathologic fractures (tumor, infection), segmental fractures (multiple fracture lines). Distal humerus: Virtually all displaced intra-articular fractures require surgery for anatomic joint restoration. Non-operative treatment results in severe stiffness and arthritis. Only exception is elderly, low-demand, medically frail patients where "bag of bones" technique (minimal immobilization, early motion) may be acceptable. Decision Factors: Patient age and activity level - young, active patients benefit more from surgical restoration. Medical comorbidities - surgery riskier in patients with heart/lung disease. Bone quality - osteoporotic bone harder to fix surgically but also heals slowly non-operatively. Occupational demands - manual laborers benefit from surgical stability. Surgeon expertise - complex fractures best treated surgically by experienced surgeon. Dr. Kumar's Approach: Comprehensive evaluation with advanced imaging to determine fracture personality. Shared decision-making with patient discussing pros/cons of each approach. For borderline cases, trial of non-operative treatment with close monitoring; surgery if displacement occurs. For clear surgical indications, prompt surgery (within 1-2 weeks) provides best outcomes.

Q5.What is the cost of humerus fracture surgery and does insurance cover it?

Cost of humerus fracture fixation surgery at Arthroscenter varies significantly based on fracture location, surgical technique, implants used, and hospital stay duration. Proximal Humerus Fracture Fixation: Locked plate fixation - ₹95,000-1,45,000 including surgeon fees, anesthesia, specialized proximal humerus locking plate (8-12 screws), operating room, fluoroscopy, 2-3 day hospital stay. Intramedullary nailing - ₹1,05,000-1,55,000 (nail more expensive than plate). Hemiarthroplasty (shoulder replacement) for unreconstructable fractures - ₹1,85,000-2,65,000. Mid-Shaft Humerus Fracture Fixation: Plate fixation (ORIF) - ₹85,000-1,35,000 including 4.5mm locking plate, 10-14 screws, 2-3 day hospital stay. Intramedullary nailing - ₹95,000-1,45,000 including antegrade humeral nail and locking screws. Distal Humerus Fracture Fixation: Dual plating (orthogonal or parallel) - ₹1,25,000-1,95,000 including two specialized distal humerus plates, 16-24 screws, possible olecranon osteotomy fixation, 3-4 day hospital stay, longer operating time. Total elbow replacement for unreconstructable fractures - ₹2,45,000-3,45,000. Open Fracture Treatment (any location): Add ₹30,000-85,000 for wound debridement, possible external fixation, antibiotics, longer hospital stay (5-7 days), higher infection risk requiring additional care. Multiple surgeries often needed for severe open fractures. Cost Breakdown Typically Includes: Pre-operative consultation, X-rays, CT scan if needed, laboratory tests. Surgeon professional fees (₹35,000-65,000 depending on complexity). Anesthesia fees (₹15,000-25,000). Operating room and equipment charges. Implants (plates, screws, nails) - often 40-50% of total cost. Hospital room charges (ICU if needed initially, then general ward). Medications, dressings, physiotherapy during hospital stay. Initial follow-up visits and X-rays first 3 months. Additional Costs May Include: Nerve conduction studies if radial nerve palsy (₹5,000-8,000). Extended physiotherapy sessions (₹600-1,000 per session, typically 20-30 sessions needed). Wrist splint for radial nerve palsy (₹2,000-4,000). Hardware removal surgery if needed (₹45,000-75,000, typically 18-24 months after initial surgery). Treatment of complications if they occur (infection, nonunion). Insurance Coverage: Most health insurance policies in India cover traumatic fracture surgery as medically necessary. Coverage typically 70-90% of total costs depending on policy and sum insured. Cashless facility available at Arthoscenter for major insurance providers (Star Health, HDFC Ergo, ICICI Lombard, New India, etc.). Pre-authorization required for planned surgery - emergency trauma cases receive post-authorization. Motor vehicle accident cases may be covered by third-party insurance. Worker's compensation may cover workplace injuries. Government employees may have coverage through CGHS/ECHS. Important: Implant costs are significant - confirm insurance coverage for specific implants before surgery. Room rent limits in policy may affect total coverage. Co-payment clauses apply in some policies. Dr. Kumar provides detailed cost estimates during consultation, assists with insurance pre-authorization, and offers payment plans for out-of-pocket expenses when needed.

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