Proximal Humerus Fractures

A proximal humerus fracture is the most common fracture of the shoulder which occurs at the upper end of the arm bone. Fractures to this region are common both with high-energy injuries in people of all ages, as well as with simple falls usually onto an outstretched hand, in older people with osteoporosis, a condition where the bone density decreases. The upper end of the humerus will break if sufficient force is directed towards it. This fracture in an elderly individual is usually called a "fragility fracture". In younger people, fractures of the shoulder usually occur from high-energy trauma or from a fall from a height.

Proximal Humerus Fracture

Symptoms

  • General complain of shoulder pain after a fall
  • Swelling and ecchymosis (bruise) in shoulder which can expand into chest wall and lower arm
  • Numbness over the outside of the shoulder indicating auxiliary nerve injury
  • Assess for head injury, Loss of conscious (LOC), cardiac/neurologic reasons for fall.

The fracture may be a simple 2-part one where there is one break and 2 fragments. However, most of the times, the fracture is multi-fragmentary and complicated. The head of the humerus (ball part of the joint) may sometimes be dislocated or even split. Generally these types of fractures are associated with poorer outcomes than the 2-part fractures.

Investigation

  • X-rays are helpful for basic diagnosis of the injury.
  • CT scans provide the surgeon with a 3D picture of the fracture and helps your surgeon plan for surgery.
  • MRI scans, although not routinely necessary, are useful to delineate the soft tissues and in particular the rotator cuff to decide if there is an injury which can be concomitantly repaired.

Treatment Procedures

Nonsurgical
Surgical