FAQs on Proximal Humerus Fractures
Proximal humerus fractures or fractures in the upper end of the humerus is the third most prevalent of fractures affecting the elderly. It accounts for about 6% of all fractures reported. Though these fractures correlate with age, athletes and younger patients also suffer from proximal humerus fractures due to high-energy shoulder trauma.
What is proximal humerus fracture?
A proximal humerus fracture refers to broken humeral head attached to the shoulder joint. Shaped like a ball, the upper end of humerus fits into the glenoid cavity socket and facilitates the movement of the arm. When there is a direct blow to the joint, most possibly a fall on an outstretched arm, the humerus head is broken. This is called proximal humerus fracture in the medical annals.
Proximal humerus fractures get the name from the word ‘proximal humerus’ denoting upper end of the humerus or arm bone. About 20% of these injuries are of complicated nature leading to fragmented and displaced bone fractures. All others are stable breaks that heal with care and conservative treatment. These fractures are often called as shoulder fractures due to their impact on the shoulder and most prominent in those with osteoporosis.
What are the symptoms of proximal humerus fractures?
- Severe pain
- Swollen or bruised shoulder
- Restricted ability to move the shoulder
- Grinding sensation as you move your shoulder
- Shoulder deformity
How does a proximal humerus fracture occur?
Your shoulder has three bones – humerus, scapula, and collar bone – joined with each other by muscles, ligaments, and tendons. Glenohumeral joint is the place where humerus and scapula are joined through a ball-and-socket articulation. The humeral head shaped as a ball rests in a concavity in the scapula. When there is any blow to the arm bone or the joint, fractures occur on the top end (ball) of the humerus due to its structural and functional characteristics.
A fracture in the arm bone can be just bone cracking or displacement of anyone of its “four parts –humeral head, greater tuberosity, lesser tuberosity, and humeral shaft.” Displacement happens when a fracture cause a bone displacement of at least 1 cm with angulation exceeding 45 degree. Proximal humerus fractures are of various types.
- One part fractures: One or more fracture lines in one or more parts, no displacement
- Two-part fractures: Fracture lines in two or more parts, one displaced.
- Three-part fractures: Fracture lines in at least three parts, two displaced.
- Four-part fractures: Fracture lines in all four parts with three displaced.
What are causes of proximal humerus fractures?
- High-energy traumatic blow impacting the shoulder joint
- Fall on outstretched arms
- osteoporotic humeral bone
- seizures or electric shock leading to fall from a height
- posterior shoulder dislocation
What are complications of proximal humerus fractures?
If left untreated properly, proximal humerus fractures may cause disability, restrict mobility of the arm, and damage nerves and blood vessels. Researches show that at least a third of such fractures cause neurovascular injuries. Damage to axillary and brachial artery is rare but possible.
Avascular necrosis may also impact the head of the humerus due to the stoppage of blood supply. Glenohumeral dislocation and rotator cuff injury are among other associated complications.
Who are at the risk of proximal humerus fractures?
Elderly and those with osteoporosis are at enhanced risk of proximal humerus fractures. The fractures are also common in osteoporotic patients and those with greater threat of shoulder dislocation.
How is proximal humerus fracture diagnosed?
Doctors recommend for x-ray of the upper end of the humerus whenever physical examination indicates potential fracture. In difficult and complicated cases, computed tomography or CT scan may and similar advanced technologies are employed.
What are the treatment methods available for proximal humerus fractures?
- Non-operative Treatment
The most common non-operative treatments for proximal humerus fractures include the following methods.
- Adequate rest and avoiding high-impact activities
- Self-care, icing, mild massage, nutrition intake
- Sling or brace immobilization
- Physiotherapy and progressive rehab
Over 85% of proximal humerus fractures are successfully treated with non-operative procedures. Even most common minimal displaced fractures and the surgical neck fracture are treated without surgery. Rest and self-care ensures there is no impediment to the self-healing process while nutritional intake accelerates the bone growth. Supporting sling or brace keep the humeral head aligned and prevents any chance of displacement or malunion. Physical therapy based on individualized need promotes healing and restore functional and structural vitality.
The treatment requirement and result vary from patient to patient depending on age, level of activity, bone displacement, type of fracture, and the dominance of the hand.
- Surgical Treatment
If there are bone fragmentations or bones are shifted out, surgery is the appropriate procedure to treat proximal humerus fractures. This may include any of the following procedures.
- Closed reduction and percutaneous pinning with minimal skin excision and for those with good bone quality or fixation using external pins
- Open reduction and internal fixation using implants, such as screws, rods, or plates
- Intramedullary rod implant
- Hemiarthroplasty or replacing humeral bone with a metal device
- Total shoulder arthroplasty or total implant
Most surgical procedures focus on realigning or replacing the damaged bone. There is long rehabilitation process following these surgeries.
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