Proximal Humerus Fracture
What is a Proximal Humerus Fracture?
A proximal humerus fracture is a break in the upper part of the arm bone, near the shoulder, often caused by falls or trauma.
- Fracture near the humeral head
- Common in older adults with osteoporosis
Overview of the Condition
These fractures can be non-displaced or involve multiple fragments. Treatment depends on fracture pattern, displacement, and patient factors.
Symptoms
- Shoulder pain and swelling
- Bruising around the upper arm
- Difficulty moving or lifting the arm
Causes
Often results from low-energy falls in older adults with reduced bone density, or from high-energy trauma in younger patients.
Diagnosis
X-rays show fracture configuration. CT scans can clarify complex patterns. Neer classification helps guide treatment.
Treatment Options
- Non-surgical: sling/immobilization for stable or minimally displaced fractures
- Surgical: ORIF or shoulder arthroplasty for complex fractures
- Rehabilitation to restore range-of-motion
Conservative Management
Immobilize in a sling initially to allow bone healing. Early gentle exercises help reduce stiffness. Pain control with NSAIDs or acetaminophen.
Rehabilitation Exercises
- Passive pendulum exercises
- Gradual active range-of-motion exercises
- Strengthening rotator cuff once fracture is stable
Surgical Options
Open reduction and internal fixation (plates/screws) or hemi-/reverse shoulder arthroplasty if the fracture is severely displaced or the head is not salvageable.
Anatomy Overview
The proximal humerus includes the head, greater tuberosity, lesser tuberosity, and surgical neck. Fracture displacement can disrupt rotator cuff function.
Affected Areas
- Humeral head
- Tuberosities (attachment sites for rotator cuff)
Frequently Asked Questions
| Question | Answer |
|---|---|
| How long before I can move my arm freely? | Most patients start gentle motion in a few weeks, with full recovery taking months. |
| What if the fracture doesn’t heal properly? | Malunion or nonunion can require surgical intervention to restore alignment. |
Prevention Strategies
- Fall prevention measures at home
- Bone health management (osteoporosis screening)
- Safe sports techniques