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. Proximal humerus fractures occur at the top or just below the humeral head (the “ball” of the ball-and-socket 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 with osteoporotic bone following a fall on an outstretched arm.
What causes proximal humerus fractures?
Fractures of the proximal humerus are usually the result of trauma, and are especially common among elderly patients. Frequent causes include a serious fall, forceful collision, or car accidents. The position of the arm and body at the time of trauma will determine the pattern and severity of the fracture and if there is an accompanied dislocation.
What are the symptoms?
A fracture of the proximal humerus causes pain and limited range of motion. After several days, there may be intense bruising (ecchymosis) around the shoulder and down the arm. Other signs and symptoms of a proximal humerus fracture include:
- Intense shoulder pain
- Inability to move the shoulder or the arm without pain
- Bruising and skin discoloration
- Swelling from the shoulder to the hand
- Tenderness in the shoulder joint
- A grinding sensation when the shoulder is moved
- A deformity under the skin at the site of the break
How are proximal humerus fractures diagnosed?
The primary goal during clinical evaluation of a proximal humerus fracture is to determine the fracture pattern – how many bone fragments there are and how far those fragments are separated (or displaced). This can be determined by taking several x-rays of the shoulder. In some complex fractures, a CT Scan with 3D imaging may be necessary to further assess the fracture pattern and assist with pre-operative planning.
What is the treatment for a proximal humerus fracture?
The fracture pattern will largely determine whether your fracture shoulde be treated with or without surgery. Other factors will be also considered including your age, general health, and activity level.
Nonsurgical – Most fractures of the proximal humerus can be treated without surgery if the bone fragments are not shifted out of position (displaced). Nonsurgical treatment generally requires the use of a shoulder immobilizer in order to allow the bone time to heal. Gentle range of motion will be started gradually over time. X-rays of the shoulder will be taken every couple of weeks to confirm the fracture is healing properly.
Surgical – Proximal humerus fractures may require surgery in order to fully restore normal shoulder function and strength. Surgical treatments range from relatively simple to more complex based on the fracture pattern. When humerus fracture repair is necessary, 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.