Proximal Humerus Fractures

The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.

Anatomy

The humerus is the largest bone in the upper arm and can be divided into proximal, middle and distal segments. The proximal humerus is made up of the humeral head, along with the greater and lesser tuberosities. The rotator cuff tendons attach to the greater and lesser tuberosities and the humeral head articulates with the glenoid to make up the shoulder joint.

What happens in a proximal humerus fracture? 

When the proximal humerus is fractured (broken) there will be pain, swelling and commonly limited movement. As the proximal humerus makes up the shoulder joint and attachment sites for the rotator cuff, stabilisation and anatomical restoration will help maintain good functional outcomes in the future.

What are the common causes? 

Most proximal humerus fractures are caused by a fall or direct trauma to the shoulder.

  1. Low Energy Injury – This is commonly caused by a fall from a standing height. A patient’s osteoporotic bone can be a contributing factor.

  2. High Energy Injury – These injuries are due to more forceful contact, such as a fall from a height, motor vehicle accident or sporting tackle.

What are the preferred Investigations/Imaging? 

  1. Plain X-Ray of the shoulder - This should include an Anterior/Posterior, Glenohumeral Joint and Lateral views.

  2. CT scan of the proximal humerus - This is commonly used to further quantify and accurately diagnose the fracture lines through the proximal humerus.

What are the treatment options?

  1. Non-operative – This treatment may be reserved for less active patients and involves pain relief, sling and progressive physiotherapy after a few weeks.

  2. Open Reduction and Internal Fixation – In active patients the fractured fragments of bone in the proximal humerus are restored to their anatomical position via an open approach and stabilised with a plate and screws.

  3. Shoulder Hemiarthroplasty – In a small percentage of young active patient’s fixation is not possible due to the severity of bone loss and comminution of bone. In these cases, the humeral head is replaced with a pyrocarbon/metal head (half a shoulder replacement).

  4. Reverse Total Shoulder Replacement – In elderly patients who have a significant bony injury which is not repairable, then a RTSR aids as the best surgical option to help restore function.

What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after upper limb surgery please see our Rehabilitation Protocols here.