Fracture of the Arm (Broken Arm)

First aid for a suspected broken arm

1. Keep the arm still. Support it in the most comfortable position, usually bent across the chest, with a sling made from a scarf or folded towel. Do not try to straighten it.
2. Remove rings, watches and bracelets before swelling makes it impossible.
3. Control bleeding with a clean pad and gentle pressure, avoiding pressure on bone ends. Cover any wound.
4. Apply ice wrapped in a cloth for up to 20 minutes to reduce swelling and pain.
5. Do not eat or drink if the arm looks deformed, in case surgery under anesthesia is needed.
6. Get to an ER or urgent care. Call 911 or your local emergency number for open fractures, a pale or numb hand, or other serious injuries.

Symptoms of a broken arm

• sudden, severe pain at the time of injury, often with a snap or crack
• swelling and bruising within hours
• deformity: a bend, bump or shortening of the arm
• pain that is worse with movement or pressure on the bone
• inability to use the arm, turn the hand, or bend the elbow
• tingling or numbness in the hand if a nerve is stretched or pinched

Some fractures, especially hairline breaks and scaphoid fractures at the wrist, cause only moderate pain and little swelling. Tenderness pinpointed on one spot of bone after an injury is a reason for an X-ray.

Types of arm fracture

Children's bones are softer, so they often get buckle (torus) fractures, where the bone squashes but does not break through, and greenstick fractures, which bend and crack on one side. Fractures through growth plates need careful follow-up.

How a broken arm is diagnosed

A clinician checks the skin, pulses, finger color, sensation and movement, then orders X-rays from at least two angles, including the joints above and below. A CT scan helps plan surgery for complex elbow and wrist fractures. MRI can find hidden fractures, such as a scaphoid fracture, if early X-rays are normal.

Treatment

Without surgery

• Reduction: if the bones are out of line, they are gently realigned under sedation or local anesthetic.
• Immobilization: a splint first, while swelling settles, then a cast for several weeks. Upper arm fractures are often treated in a sling or a functional brace.
• Pain relief: acetaminophen (paracetamol), ibuprofen at the label dose, or stronger prescription medicine for a few days. Avoid NSAIDs if you have kidney disease or stomach ulcers.

With surgery

Surgery is used when bones are badly displaced, unstable, broken into several pieces, involve a joint surface, are open, or have injured blood vessels. Options include plates and screws, rods inside the bone, pins (common in children) and external fixators.

Caring for your cast

• Keep the arm raised above heart level for the first 2 to 3 days.
• Wiggle your fingers often.
• Keep the cast dry, and never push objects inside to scratch.
• Seek help urgently for increasing pain, numbness, pale or blue fingers, or a cast that feels too tight.

Complications

• Compartment syndrome: dangerous pressure build-up inside the forearm muscles. Pain that is out of proportion and worse with finger stretching needs emergency care.
• Nerve injury: for example radial nerve injury with humerus shaft fractures. Most recover over months.
• Malunion or nonunion: the bone heals crooked or fails to heal.
• Stiffness, especially of the elbow and shoulder.
• Complex regional pain syndrome: prolonged pain, swelling and skin changes.
• Infection, especially with open fractures or surgery.

Recovery and broken arm healing time

Children's fractures usually heal in 3 to 6 weeks. Adults usually need 6 to 8 weeks in a cast or sling, and up to 12 weeks or more for complex breaks. Full strength and movement may take several months. Physical therapy after immobilization is important to restore elbow, wrist and shoulder movement.

Older adults with a wrist or upper arm fracture after a simple fall should have a bone density test, because the break may be a sign of osteoporosis.

Frequently asked questions

How can I tell if my arm is broken or just bruised?

A broken arm usually causes severe pain at one spot on the bone, swelling, deformity, and difficulty moving or using the arm. A bruise hurts less and improves within a few days. Only an X-ray can confirm a fracture, so get one if pain persists or the arm looks misshapen.

How long does a broken arm take to heal?

Most arm fractures heal in 6 to 12 weeks in adults and 3 to 6 weeks in children. Regaining full strength and movement can take several months, especially after surgery or elbow fractures.

Can you move your fingers with a broken arm?

Often yes. Being able to wiggle your fingers does not rule out a fracture. Fingers that are numb, pale, cold or cannot move, however, suggest nerve or blood vessel damage and need emergency care.

Do all broken arms need a cast?

No. Some small or stable fractures, such as buckle fractures in children, are treated with a removable splint. Many upper arm fractures are treated in a sling or brace. Unstable fractures may need surgery instead of, or before, a cast.

When should I go to the ER for a broken arm?

Go to the ER for any suspected broken arm, and call 911 if the bone is through the skin, the hand is cold, pale or numb, or there are other serious injuries.