What is a proximal humerus fracture?
The humerus (also known as the upper arm bone) is a long bone that runs from the shoulder to the elbow. The proximal humerus is the top portion of this bone, and is very important because it forms half of the shoulder joint. Fractures in this area can damage the surface of the shoulder joint, leading to painful arthritis, can also affect both the strength and range of motion of the arm. Proximal humerus fractures are commonly seen in older patients after a fall on an outstretched arm, but can also occur as a result of direct trauma or car accidents.
What happens during surgery for proximal humerus fractures?
Proximal humerus fractures may require surgery in order to fully restore normal shoulder function and strength, especially in fractures with a large degree of displacement. Surgical treatments range from relatively simple to more complex based on the fracture pattern. Surgery typically involves fixation of the fracture fragments with plates, screws or pins. If proper alignment cannot be achieved in severe fractures, they may require replacement of the shoulder joint.
- Closed Reduction Percutaneous Pinning (CRPP) – Simple fracture patterns may be treated by placing metal pins through the skin and into the bone fragments to hold them in the correct position as they heal. This procedure is done in the operating room with the aid of a special x-ray machine called a fluoroscope, which allows the surgeon to see the bones and guide the placement of the pins.
- Open Reduction Internal Fixation (ORIF) – If the fracture pattern is more complex, an ORIF may be recommended in order to realign the broken bones and hold them in place with special hardware, like a plate and screws.
- Hemiarthroplasty – If there is extensive damage to the proximal humerus, replacement of the humeral head with an artificial prosthesis may be required. The new metal head is attached to a stem, which is inserted down the bone canal of the humerus. This procedure is typically used in younger patients (under 65) with complex fractures, and is also sometimes used as a back-up for ORIF if reduction of the fracture cannot be obtained with a plate and screws.