Fracture Proximal Humerus
Fractures of the proximal humerus are common, accounting for 5% of all fractures. These fractures tend to occur in older patients who are osteoporotic. Less than one in five patients present a management challenge.
The uppermost portion of the bone in the arm (humerus) and the socket (glenoid) of the shoulder blade form the shoulder joint. Fractures involving the upper humerus are called “proximal humerus fractures” (proximal meaning uppermost). The proximal humerus contains the humeral head and the tuberosities. The tuberosities are prominent attachment sites for the tendons of the rotator cuff. There is a smaller tuberosity in the front (lesser tuberosity) for the attachment of the subscapularis, and a larger one on the side and back (greater tuberosity) for the attachment of the remaining rotator cuff tendons (supraspinatus, infraspinatus, and teres minor).
Causes of Fracture Proximal Humerus
- The injury usually occurs during a fall directly on the point of the shoulder or on outstretched hands.
Presentation:
Usually after a fall, sports injury.
Pain and swelling over the shoulder and inability to lift arm above head. Examination of skin overlying the shoulder. Check for any nerve or vascular damage.
Diagnosis:
A plain Xray is used to diagnose the fracture. A CT scan is usually ordered to assess the fracture in more detail.
Treatment:
This depends on patient factors and the fracture pattern. The vast majority of these fractures can be treated without surgery.
Non Operative Treatment
The vast majority proximal Humerus fractures are treated non-operatively with short term immobilization.
- Immobilization. A sling is recommended, keeping the arm immobilized for about 2 to 3 weeks, but the amount of time can vary on the fracture type, age of the patient, and other medical conditions.
- Pain control. Regular nonsteroidal anti-inflammatory drugs, including ibuprofen, and/or other pain medications during the healing process.
- Range-of-motion exercises. Gentle range-of-motion exercises may begin 7 to 10 days after injury.
- Physical therapy. Physical therapy can start 2 to 3 weeks after the injury occurs.
Surgical Treatment Recommended if:
- Significantly displaced Fracture / Joint.
- Head Split fractures.
- Open Fractures.
The surgery involves ‘Proximal Humerus Fracture Fixation’ using a plate, sutures and screws or nail. In patients with low demand and with soft bone or head split fractures a ‘Reverse Shoulder Replacement’ may be considered.