Proximal humerus fractures
What is a Proximal Humerus Fracture?
It is a fracture of the upper arm bone (the humerus) and is also called a shoulder fracture. It may be partial or complete. A partial fracture is an incomplete break. A complete fracture breaks the bone into pieces. A fall on an outstretched arm is the main cause of a proximal humerus fracture. However, a direct blow to the shoulder can also cause a broken shoulder.
The bone is usually broken at or near the ball or head of the upper arm bone and can often impact shoulder muscles.
This is a common fracture in people over the age of 65 with osteoporosis. Other risk factors include diabetes, epilepsy, and being female. With the aging of the population, the incidence of these fractures will increase. Many proximal humerus fractures can be treated non operatively.
The fractures can also cause nerve injury. Symptoms include pain, bruising and swelling and difficulty raising the affected arm.
Types of fractures
A nondisplaced fracture means there is a crack in the bone, but the pieces of the bones are in te correct position. A displaced fracture is when the bone breaks into two or more pieces, and the pieces don't line up. A minimally displaced fracture is when there is a slight shift in position of the bone pieces.
How is a proximal humerus fracture diagnosed?
Dr. Johnston will ask how you injured your shoulder and your symptoms. He will conduct a complete evaluation of the shoulder including testing nerve and muscle function. The diagnosis is made with x-rays.
When indicated and in preparation for surgery, Dr. Johnston will order imaging studies including a CT scan to see the details of the fracture more clearly, and an MRI may be needed to assess rotator cuff health.
What are the treatments?
A proximal humerus fracture is a serious injury that requires immediate treatment to preserve joint function. When the broken pieces remain in alignment, they can usually heal on their own. For nondisplaced and minimally displaced fractures initial treatment involves icing to control pain and swelling, and sling immobilization with early range of motion exercises. The shoulder will be immobilized for up to six weeks. NSAIDS will control pain and swelling. For more complex and displaced fractures surgical fixation is indicated.
Recovery after non-surgical treatment depends on your age and health before the injury. It can take 6-8 weeks for the bone to heal, plus physical therapy for 3-6 months can restore function and daily life activities. Physical therapy is essential since a significant issue with these types of fractures is loss of range of motion (contracture). Other potential problems may include infection, a fracture that does not heal or heals poorly, nerve injury, deformity, and impaired blood supply.
When the bones are not in alignment and when there is more than one break in the bone, surgery may be required to realign the bones or to replace the shoulder joint. Surgery to realign the bones will involve the use of metal parts including plates, screws, and wires to hold the bone together. It could also mean that a nail is placed in the bone to align the fracture pieces. The procedure may be performed as open surgery or a closed where the bone fragments are manipulated into correct position. After the bone are put back into alignment, the arm will be put in a sling while the bone heals.
Dr. Peter Johnston is an expert in complex shoulder injuries and has written book chapters on the management of proximal humerus fractures! He is an assistant professor in the Georgetown University Department of Orthopedic Surgery and a fellowship trained by the best shoulder surgeons in the world. When you need a shoulder surgeon, call Dr. Johnston. He will meet you at the hospital where you will receive world class care.
