Weeks 6-12: Strengthening Phase Sling: No sling. Gently press your fist into the wall for two to three seconds. Humeral shaft fractures are common fractures of the diaphysis of the humerus, which may be associated with radial nerve injury. After the operation, the arm immobilization is done using the sling support (or shoulder spica) for 6 weeks. Your main aim is to restore enough movement to do day to day activities. Read more: How Long After Breaking an Arm Can I Resume Weightlifting? Keep the arms flat on the table to make a good base of support to perform elbow exercise. You may remove the sling for personal hygiene and for your exercises but do not remove the brace. This is a very painful injury due to muscle spasms and the bone ends moving. Results of surgical treatment of nonunion of humeral shaft fracture with dynamic compression plate and cancellous bone grafting. This is a special situation that needsa different treatment approach altogether and it is beyond the scope of this post. orthopedic doctor had determined that your humeral fracture has started following injuries or post-operations, See all the conditions our hand therapists treat here. After a few days, hold a soft ball/ball of socks. Once your bone begins to heal, the pain will decrease and your doctor may start gentle shoulder and elbow exercises. Ice or cold flow systems encouraged for the first week at a minimum: should be used 3-4 times per day. There may be damage (or risk of damage) to the brachial artery. Footer. Repeat each exercise 10 times. shoulder and the elbow. Conservative management is the treatment of choice for most humeral shaft fractures . wrist and hand to prevent IM nails can be used to stabilise a humerus fracture that is __ Trunk exercises for sport specific activities (i.e. In both conservative and surgical management the immobilization is done for certain weeks. After a humerus fracture, your ability to move your shoulder, called range of motion, will be limited. Holliers Hill, Bexhill-on-Sea, East Sussex, TN40 2DZ Pain > Shoulder 3 0 obj When you have the chance, please tell your family, friends and physicians about the positive results and experience you have had in our physio clinics. The patient must complete range of motion, strengthening and other exercises prescribed by the doctor on a daily basis. depending on the location and direction of the break and the associated Perform 10 repetitions in each of these directions: clockwise, counterclockwise, forward/backward and side to side. Tendon problems are common in runners and can become a persistent issue if not properly treated. For this, simply grasp your hand and elevate it to the maximum point where you can take it to. Keep Reading: Supracondylar Fracture of Humerus: Physiotherapy management. It is one of the big three bones of the body. "XnT!eW-a,k't`IJQGCK>L]_"TFAM;{C7"OF`o/r^&_Q#?=7mZ_Q~eEFzL5Y[67TL.zc1ZkT3(J{'D.q!6ag,nqtYAXw =4CABl6Vyh >/H6w [,ChDo4YcGX* J0la&I4G5;K Nonunion is a difficult problem and occurs when the fracture doesn't heal. These all sat under my brace and close to the bottom of it; rubbing painfully on it and weeping. They will advise you on further exercises and on-going management. It is frequently exchanged for functional bracing 1 to 2 weeks after injury. Strengthening exercises can begin as early as three weeks after injury, depending on its severity. Ortho.Boston is a private Orthopedic Surgery practice located in Needham Heights, MA. The Virtual Fracture Clinic letter will detail where the fracture is. Many people will have long-term shoulder stiffness after a proximal humerus fracture. Slowly lower back down. Notify me of follow-up comments by email. Rotate it clockwise 15 to 20 times and then anticlockwise 15 to 20 times, however, you can perform this exercise as many times as you could. Injuries to the radial nerve are fairly common in a mid-shaft break because this important nerve tightly wraps around the middle of the humerus. An open fracture may require surgery though - your doctor will repair the humerus with screws, plates, or a metal rod. The patients cooperation is essential to the rehabilitation process. Please understand that it is really important to When there is direct injury or assault on the arm, the bone may break into multiple pieces. Phase-3: Week 6 to 10. However, if a nonunion does occur, then surgery is almost always needed to stimulate a healing response of the bone., Carroll EA, Schweppe M, Langfitt M, Miller AN, Halvorson JJ. Patients may also receive the following physiotherapy treatment modalities: Phoenix Rehab Group works with specialist physiotherapists and rehab therapists who are highly trained, qualified, experienced and passionate to provide high level of expert care to our patients. > Conditions Avoid making sudden movements on the humerus fracture. Most of the time, the humeral fracture is secured Rest: Try to rest your shoulder for the first 24-72 hours. humerus fractures (such as in radial nerve damage). Rotation of your arm toward your body and away from your body is also strengthened with resistance band exercises as part of your recovery plan. Hold two to three seconds and then slowly return to the starting position. As listed in our website are the list of services we provide our clients as referred by their medical doctors or by self referrals/word of mouth, but you can also make an appointment without seeing any doctors (that being said, if you do need a referral to a specialist orthopedic surgeon or sports GP, we will recommend you too as value added service at no additional costs to you). Healing of a mid-shaft humerus fracture with non-surgical treatment generally takes ten to twelve weeks. Move 1: Pendulums Pendulums use momentum from your body to gently move your shoulder. Secure one end of the band to a sturdy object, such as a doorknob, at waist-height. holding the humerus in place. Rehabilitation Programs for Non-Operative Humeral Fractures Dr. Rolf . stiffness and weakness from developing and it is usually fine to take It can also happen due to sudden and opposite movement of the arm against the violent contraction of the muscle. Kings Drive, Eastbourne, East Sussex, BN21 2UD You'll need surgery to repair a comminuted fracture if one of your long or large bones is broken. humeral fractures, however, which are also known as. The humerus bone is the long bone that is located between the shoulder and the elbow. Following a proximal humerus fracture, physical therapy will be crucial to restore proper function of your shoulder and arm. If you have stiffness in your elbow or hand from wearing the sling, you may wish to perform these exercises first. **to be worn day and night; off for hygiene and exercises. shoulder exercises every day until you have regained full. One reason to avoid surgeryis to prevent the risk of nonunion. Some people can recover without surgery and only need a splint, cast or sling. nonoperative and operative treatment of humeral shaft fractures, however, requires an understanding of humeral anatomy, the fracture. If ignored, the elbow joint stiffness can become very difficult to get rid of. After the fracture reduction, the immobilization of the arm is done for 6 to 8 weeks using one of the following ways. Lineage Medical, Inc., OrthoBullets. Falls are a common cause of humerus fractures. In some rare cases, there may be mal-union, delayed / non-union. Depending on how and where your bone breaks, different treatments are needed. The mid-shaft of the fibula was harvested and shaped to fit the medullary canal. An X-ray of the shoulder will be taken on a weekly or biweekly (every two weeks) basis to confirm the fracture is healing properly. It has a rich blood supply and this is why any fracture on the shaft readily heals. This might happen in the part of the humerus near your shoulder, near the middle of the humerus, or in the part of the humerus near your elbow. required. Seek immediate medical attention if you notice numbness or circulation problems. Nonoperative treatment is usually with a sling or shoulder immobilizer with no shoulder mobility for the first two weeks. mobility exercises. as the nerve wraps around the back of the humerus, with between 8-15% of Blade Pain > Humerus Fracture Physiotherapy. Fractures of the humerus can occur proximally, at the shaft, or distally. These fractures can be caused by car accidents, sports. Spiral fractures of the humerus in toddler age and younger are strongly linked . PHASE I: IMMOBILIZATION . With progress in surgical methods and implants, surgical treatment of clavicle fractures has become more popular. You also need to take antibiotics intravenously when you have an open fracture. Stand facing a wall with your elbow bent to 90 degrees and fingers in a gentle fist. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. This process is typically known metal plate that are securely held in place by screws. Healing of a mid-shaft humerus fracture with non-surgical treatment generally takes ten to twelve weeks. You will be fitted with a brace and a sling. position. When we have fractured our bone of the arm, it is actually the fracture of the humerus bone. need to be realigned and held in place. Reasons to consider surgical treatment include: However, surgery comes with additional risks, including nerve injury and failure of the bone to heal. Hold for 5 seconds and repeat 10 times. the doctor to see where the fracture is, what type of fracture it is, Thereafter, the patient will be given weekly exercises to slowly increase the shoulders range of motion. Pain medication, including acetaminophen, can help relieve pain as the fracture heals. Extensor muscle brings extension/ straightening of the elbow joint and is present on the back of the elbow. The most common surgical treatment of a humerus fracture is to place a large metal locking plate along the humerus and secure it with screws. Learn how to conduct effective rehabilitation exercises to heal a radial head fracture elbow. Methods: We conducted a retrospective chart review of patients aged over 18 years with humeral midshaft fractures treated . 05n~=x{"\b Follow up sessions are inline to provide you have an open fracture you will be given additional antibiotics to This includes, but is not limited to: Distal Humeral Fracture 812.4 Supracondylar Humeral Fracture 812.41 Elbow Fracture 813.83 Proximal Radius/Ulna Fracture 813.0 Radial Head Fractures 813.05 . flow to tired, tight and tense muscles toaccelerate recovery andshorten downtime / recovery period required. - Antegrade interlocking nailing of humeral shaft fractures. Radial Nerve Injury. Read the benefits of regular deep tissue release therapy here. There are two types of humerus fractures based on the location of the break(s). enough functional range for their day to day activities (we will always aim for 100% of course). The majority of both proximal and midshaft humerus fractures are nondisplaced and can be treated conservatively (nonsurgically). bone). hb```,@(aCXl8bPF3f4)i9y|2\1fH3Qfa`JK-ag`2j 59 In some cases a The two complications often seen are injuries to the radial nerve and nonunion of the fracture. will keep your muscles healthy and fit with body/movement-confidence. Place the pillow between your elbow and the wall. However, there's much more holding your arm together than bone, so don't let the X-ray scare you. because if you stop too soon, or Repeat 10 times. Physiotherapy Exercises following a Proximal Hummus Fracture WesternTrust 5.25K subscribers Subscribe 105K views 2 years ago Show more Fractured Humerus (Broken Arm): Everything You Need To. Rotate it in both clockwise and anticlockwise directions. The shaft of humerus fracture can be of three types. 0300 131 4500, Eastbourne District General Hospital exercises and daily activities such as eating, dressing, and bathing . Doctors; Therapy. Be aware of peripheral nerve palsy signs Avoid exercises which reproduce the mechanism of injury Early intervention is the key to a successful recovery. So the mid-shaft region of the humerus is the long, thin part of the - we usually start shoulder exercises with very safe We will help you get started with active exercises for the elbow, The humerus, or upper arm bone, forms part of your elbow joint at its bottom end and your shoulder joint proximally, at the top of this bone. Please feel free to contact me at nigel@phoenixrehabgroup.com or WhatsApp us at 88001830. If there is any pressure through the elbow it Patients receiving a conservative treatment are generally immobilised 4 to 6 weeks in a simple sling, with the glenohumeral joint in the resting position, in internal rotation, and 0 of adduction. When you have surgery, the soft tissues surrounding the fracture are further disrupted, and this can compromise blood flow to the site of the fracture. Surgical management is growing in popularity because it can shorten healing times and improve alignment. Proximal Humerus Fracture Rehab Protocol Keys to a Successful Outcome Tuberosity healing must occur before active force is applied by the attached rotator cuff tendon "Slower rather than quicker" overall No not stress end range motions between 0-6 weeks while performing passive movements In this article, we will cover physiotherapy management for the fractured shaft of the humerus bone. Find out what moves can help speed up the healing. Apply this to the sore area for up to 15 minutes, every few hours ensuring the ice is never in direct contact with the skin. Copyright 2008-2023 Physiosunit is a sister website of, Copyright 2023 Physiosunit | Powered by, Physiotherapy management for fracture shaft of humerus, Wrist circumduction exercise for shaft of humerus fracture, Forearm supination, pronation exercise for broken arm, Progressive strengthening exercises for broken arm, 3 Fracture Humerus Classification, Its Sub-Type Simplified, Supracondylar Fracture of Humerus: Physiotherapy management, 5 Easy Trigger Finger Exercises & Self-Massage Technique, 7 Easy Chronic Back Pain Exercises That Actually Work, 6 Easy Physical Therapy Exercises for Spondylolisthesis Correction in Lumbar, 3 Fracture Humerus Classification, its Sub-type Simplified, Unexplained back pain may be due to swiss cheese bone|Study, 2 Stretching Exercise for Calf Muscle Pain Relief Instantly, What is frozen shoulder: 3 Stage & Physiotherapy to Ease Pain - Physiosunit, Fracture humerus classification and causes - Physiosunit, How to Loosen Tight Shoulders? 2012;20(4):223225. The most common cause of a humeral shaft fracture is a fall, but high-energy injuries (motor vehicle collisions, sports injuries) and penetrating trauma (gunshot wounds) also can cause this injury. A coaptation splint is typically used for 7 to 10 days, until more definitive treatment is . If the fracture is unstable or if it is associated with multiple other bone fractures, then surgery is considered. let the arm hang by your side move which helps prevent stiffness. will rectify it soon. Depending on the pattern of fracture, it can be categorised into three types. *If surgery was not performed, PROM should not start until 3 weeks from the date of injury. The two complications usually encountered are injuries to the radial nerve and nonunion of the fracture. Injuries that require surgical intervention will be followed by a specific rehabilitation protocol. v!aB!`7O|KhL"zEX z=iyO%Ms$5$pDHv6.5s2 .EhDg Jonathan Cluett, MD, is board-certified in orthopedic surgery. It is important to keep the shoulder moving to prevent stiffness but not to aggravate the injury. Surgical management is growing in popularity because it can shorten healing times and improve alignment.. So strengthening the grip is also very important and it is also important to carry on with other coming exercises. Twice daily is recommended. There are a few techniques used to repair comminuted fractures, and which one your surgeon uses will depend on your injuries, which bone is fractured and any other complications after your trauma. Press and hold this position for a minimum of 30 seconds duration. Humeral Shaft Fractures. Conquest Hospital The Ridge, St Leonards-on-Sea, East Sussex, TN37 7RD 0300 131 4500. do not line up normally. Severe fractures with previous arthroscopy (joint degeneration) may require shoulder replacement. 3 0 obj Treatment can be nonoperative or operative depending on location of fracture, fracture morphology, and association with other ipsilateral injuries. Place a pillow between your fist and the wall. About 3 - 5% of all broken bones are midshaft humeral fractures and these kind of fractures tend to Exercises for Increased Shoulder Flexibility, Deutsches Arzteblatt International: "The Treatment of Proximal Humeral Fracture in Adults", American Physical Therapy Association: "Physical Therapist's Guide to Proximal Humerus Fractures", Geriatric Orthopaedic Surgery & Rehabilitation: "Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient", Mammoth Orthopedic Institute: "Rehabilitation Guidelines for Proximal Humerus Fracture (Non-Operative)". The Ridge, St Leonards-on-Sea, East Sussex, TN37 7RD In my practice, I have found elbow restriction is the most common complaint after the removal of plaster. A mid-shaft humerus fracture occurs when there is a direct blow to the upper arm. Read more: Exercises for Increased Shoulder Flexibility. However, once they become easy you can start with the posture and pendulum exercises. meetspecific individual needs, to treat a wide range of injuries rod/nail. Wear the brace and sling all the time, even in bed at night. First, on the head/ neck of the humerus; second, the shaft of the humerus and third is epicondyles of the humerus. exercises to reduce your risk of re-injury and giving you a long term The vast majority of mid-shaft humerus fractures heal without surgery, which minimizes complications. A retrospective study of 126 cases. Traditionally, humeral shaft fractures have been described according to the following features: Location - Proximal, middle, or distal. Open and close your hand as shown 10-15 times. Keeping your elbow straight, lift your arm up in front to shoulder-height. Next, move your wrist up and down. Do not push into pain. Mid-shaft humeral fractures should be followed up in fracture clinic at 1 week. %PDF-1.5 physicians, massage therapist, dietitian, craniosacral therapists and personal In most cases, there is a high likelihood that bones can be realigned . Reduction is seldom required for humeral shaft fractures. Treatment varies depending on the type and severity of the break but may include the use of a sling, brace, splint or cast and/or surgery. injury, the midshaft humerus fracture may have occurred spontaneously (yeah that can happen and does happen). Johns Hopkins Medicine. This type of fracture is where the bone has broken due to a disease Now repeat the same process by extending the wrist to stretch the flexor group of muscles. Most radial nerve injuries typically improve with time, but your healthcare provider should follow up with you in case further treatment is needed. Interestingly, one of the most common reasons for nonunion is surgery . Dowel exercises allow your uninjured shoulder to assist movement of your injured arm. % If Surgical treatment of humeral shaft fractures should be considered for multiple reasons. Pain and pathology in a tendon, known as tendinopathy, is a common injury in athletes that can be difficult to manage. This information will guide you through the next 6 weeks of your rehabilitation. The fracture becomes fragmented. It is important to receive physical therapy after your humerus starts to heal. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright 2008-2023 Physiosunit is a sister website of Physiofirst Physiotherapy Centre, Rourkela. Management of humeral shaft fractures. Stuart Hershman, MD, is board-certified in orthopaedic surgery. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. without any support through the elbow as this allows gravity to help One indication for surgery is an inability to maintain the fracture in adequate alignment with. =U_7}_^0(di /@B%aA~_,AKBb1AdFyDHKlQ"L I)U3]Ql*3;En.{MLSH0>p}\oL^GaOz#l"o?Q'~O{L-{Yo,4I FMfdl'%5>. Love the vibe of Phoenix Rehab! The back surface of This will ensure your shoulder does not become stiff and it will help the healing process. Humerus fractures are usually caused by traumas like car accidents or falls. Most distal humerus fractures are caused by some type of high-energy eventsuch as receiving a . Read more patient praise and testimonials here=), PHOENIX REHAB PHYSIOBack, Neck, Shoulder, Hip, Knee, Ankle & Hand Physiotherapy SpecialistsHome | Team | Conditions Treated | Therapy Products | Clinic Locations | Careers. Types of surgical procedures include: Healing of a mid-shaft humerus fracture with non-surgical treatment generally takes ten to twelve weeks. Mid-Shaft Humerus Fracture Treatment. and more advanced range of motion exercises. muscles from scar tissue micro-tears (and potential ruptures), and increases muscle Due to their limited movement following a proximal humerus fracture, individuals lose their range of shoulder motion and may develop stiffness of the shoulder joint. . bone. Hold for two to three seconds; then slowly lower back down. Hold for two to three seconds and then walk them back down. This exercise is recommended only if you have gained sufficient grip strength to hold the dumbbell firmly. Physio and hand therapy can help healing, We use the worlds best tendon recovery programs through cutting edge treatment techniques for all tendon injuries (and tendon injuries differ accordingly), WE TREAT MUSCLE, BONE & JOINT PAINS AND INJURIES, 10 Sinaran Drive,Novena Medical Center #10-09, Singapore 307506, 9 Tampines Grande #01-20 Singapore 528735, Back and Neck (Spinal / Spine) Pain Physio, Computerized Spinal Decompression Traction, Patients who sustained injuries to their elbows, forearms, hands, wrists In a shaft of humerus fracture case, immediately after the removal of plaster cast the most important secondary complication is elbow joint stiffness. Stand up tall and squeeze your shoulder blades together, holding a small dumbbell in your hand. 2012;20(7):423433. Though older Masks are required inside all of our care facilities. Here we have to use our opposite hand and slightly put pressure at the end range of wrist flexion and extension. These fractures separate the articular surface as a single unit from the rest of the humeral shaft. alignment is maintained despite the fracture line. Hey, do note that it is very, very important to stick with the shoulder physiotherapy program with us and to do your If this is not the case please let us know using the contact details. Metal implants are not meant to be a long term Our senior allied health practitioners (physiotherapists, occupational therapists) are registered, regulated and accredited by the Allied Health Professions Council (AHPC), an arm of Singapore's Ministry of Health (MOH). move the arm, and active assisted exercises where you use your good arm However in many of them, the attending doctor will need to confirm these fractures with imaging. Around 10% of humeral shaft fractures with require surgical treatment. One-to-one Sessions With Our Principals: No Juniors Or Assistants Involved, Ever. If the upper arm bone (humerus) fractures into two or more pieces, the jagged ends can injure nearby nerves and blood vessels. - Rotational alignment of humerus after closed locked nailing. but this doesnt usually cause any functional issues as the shoulder X-rays will be taken in different directions, usually from. For example, to stretch the flexors, slightly extend the wrist and use the other hand to give pressure over the palm. Physical Therapy While you are wearing the sling, you will likely lose muscle strength in your shoulder. Injury to the fractures, there may not have a specific incident that had directly caused the Keep the band secured at waist-height with your elbow bent to 90 degrees. J Am Acad Orthop Surg. refer to a break somewhere in the middle section of the bone. Do not push into pain. Rehabilitation will continue until the muscles, ligaments and other soft tissues perform normally. Youre in good hands with decades of Nonoperative treatment usually includes the placement of fracture bracing that will be replaced by a cylindrical brace (Sarmiento brace) three to four weeks later that fits the upper arm while leaving the elbow free. A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm. You will have another x-ray to check the position of the fracture. Pull your forearm in toward your body until it reaches your belly. 2. The doctor will tell you how long to wear the cast or splint and will remove it at the right time. If surgery is not required, your physician and physical therapist . Your email address will not be published. our therapists is best fit for your condition (, Promotions, Meg just has a sprained neck (so much better now) but I think more importantly, the senior physiotherapist has impressed on her to strengthen her muscles in light of her loose joints. Surgery usually involves fixation of the fracture fragments with plates, screws or pins. But to better understand the concept of fracture we first need to understand its related anatomy. For this you can use a silicone gel ball, you simply need to hold the gel ball and squeeze it as many times as you can. that has weakened the bone such as metastases and cancer. required. After extending it to maximum slowly bend the elbow, i.e flex it to the maximum point. General Principles of Rehabilitation for Fractures . You can do this exercise freely without holding anything, but as you progress with the exercise I recommend you to hold a cane or a lightweight rod and then move the forearm in both directions. your arm out of your sling to do these exercises. Full recovery can take nine to 12 months. Nerve or blood vessel injury. Verywell Health's content is for informational and educational purposes only. In the list of exercises for the shaft of humerus fracture, forearm pronation and supination is another important elbow joint motion to take care of. Keeping your forearm parallel to the ground, pull the band backward while squeezing your shoulder blade toward your spine. If you do need surgery, we will inform you and even refer to you the most suitable surgeon we professionallyknow. The usual indications for treating a midshaft humerus fracture surgically are: Over 90% of humerus fractures treated non-operatively will unite and Active wrist flexion extension for elbow fracture rehabilitation. endobj when the fracture is reduced so great care should be taken when Orthopedics. Having regular deep tissue and sports massagewill keep your muscles healthy and fit with body/movement-confidence. It normally takes 9-12 weeks for this injury to heal. We appreciate you as our valued clients and want you to know that the # 1 way we grow as a clinic / brand is through word of mouth referrals from valued patients like yourself. Appt Request. the humerus bone is broken at or near the top, near or at the shoulder. A mid-shaft humerus fracture occurs in the middle of the humerus bone and usually does not involve the shoulder or elbow joints. This is when a long metal rod is placed down the middle of the The bulky muscles, such as the biceps, triceps and deltoid surrounds the shaft of the humerus. See all the conditions our principal physiotherapists treat. corporate or group collaborations / pricing etc, Finger, Wrist, Forearm & Elbow Conditions, Conditions By Body Part Affected / Location, Finger, Hand, Wrist, Forearm & Elbow Conditions, Physio May Be Insurance-Covered (Must Read), Back And Neck Pain Physiotherapy (Spinal), INDIBA Activ ProRecovery System Physiotherapy, Ergonomics & Repetitive Strain Injury Prevention, Back Rest Cradle Molded Lumbar Cushion Singapore, Health Supplements For Quicker Bone & Injury Healing, Skinception Skin Care, Scar And Hair Removal Products, computerized ">@q0of `St_PY a X-rays help Midshaft: if concomitant with a radial fracture, may be called a "both . Acta Ortop Bras. Repeat this alternate flexion-extension a minimum of 15 to 20 times in a session. We'd like to assure you that were very Find more COVID-19 testing locations on Maryland.gov. The rehabilitation differs slightly from nonoperative treatment, with no splints or cast. solution and they tend to need to be removed. The upper end is known as the head, the lower end is epicondyles and the longer and middle part is known as the shaft. For advice on smoking cessation and local support available, please refer to the following website: http://smokefree.nhs.uk or discuss this with your GP. Fracture Blisters. Learn how to conduct effective rehabilitation exercises to heal a radial head fracture elbow. If you break your humerus, you might need surgery to repair your bone. Swing your arm slowly and gently forwards and backwards. degrees flexion. Sometimes this fracture gets associates with radial nerve injury resulting inwrist drop.