<s>[INST] Hello doctor, Three and a half months ago, I fractured my humerus in a car accident. When I went to the hospital I had my arm put into a sling. Since then I have been going back to the hospital every three to four weeks for x-rays, what concerns me is that my doctors seem extremely unsure what to do because my arm has healed in an awkward way. They keep saying I should leave it for a few months but I cannot see how it will ever mend properly. I insisted strongly that they put me on the waiting list to have the bone replaced and have pins put in it, but they said it might not be worth the risk. I want to know what other professional opinions so I can make a more informed decision. I have posted a picture of the x-ray. [/INST] Hello doctor, Sorry to hear about your accident. From what I see on the Xrays attached, you sustained a humeral shaft fracture. (attachment removed to protect patient identity).  These fractures tend to be very forgiving, that is, they do well in spite of a great deal of malalignment. Humerus has a thick muscle cover all around it, so healing is usually quick and predictable. The shoulder joint has an enormous range of movement. This helps in retaining the excellent function of the arm even with minor amounts of malalignment. In fact, up to 20 degrees of anterior (front to back) angulation, and up to 30 degrees of varus, valgus (side to side) angulation is acceptable. Also, unlike the legs, shortening is not much of a concern in upper limbs, and upto 3 cm of shortening is acceptable in a humeral shaft fracture. Your x-ray show exuberant callus (healing bone), and you are likely to achieve good union in due course of time. I would not worry about the x-ray appearance of your humerus. Even if it heals in a malaligned position, so long as the malalignment is within the acceptable limits, and the bony union is strong, I would consider this an excellent outcome. It is, however, advisable to continue following up with your orthopedic surgeon for repeat x-rays to make sure that the malalignment does not worsen and the healing progresses. You can try to make the x-rays look better by operating, but the function and appearance of your arm externally will remain the same, and you will be left with a surgical scar. In your case, since it has started healing, a long incision will have to be taken to open the entire bone, remove the healing callus, and realign the bone fragments. This will not only expose you to operative complications like blood loss (which will be very high because you cannot use a tourniquet for a fracture that are high in the arm) but also a risk of non-union of the fracture, as you will be stripping off the blood supply to the fracture surfaces. I hope this helps. Healing humeral shaft fracture. Healing humeral shaft fracture. Observation. </s>