Proximal humerus fracture

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Proximal humerus fracture

A proximal humerus fracture is a type of bone fracture that occurs in the upper part of the humerus, which is the long bone in the upper arm. This type of fracture is common, especially among the elderly, and can result from a fall or direct blow to the shoulder.

Anatomy

The humerus is divided into three parts: the proximal humerus, the shaft, and the distal humerus. The proximal humerus includes the humeral head, the greater tubercle, the lesser tubercle, and the surgical neck. The glenohumeral joint is formed by the articulation of the humeral head with the glenoid cavity of the scapula.

Classification

Proximal humerus fractures are classified based on the location and number of fracture fragments. The most commonly used classification system is the Neer classification, which categorizes fractures into four parts:

• One-part fracture: No significant displacement.
• Two-part fracture: Displacement of one fragment.
• Three-part fracture: Displacement of two fragments.
• Four-part fracture: Displacement of three or more fragments.

Causes

The primary causes of proximal humerus fractures include:

• Falls: Especially common in the elderly due to osteoporosis.
• Trauma: Such as motor vehicle accidents or sports injuries.
• Pathological fractures: Resulting from underlying conditions like bone cancer or osteoporosis.

Symptoms

Symptoms of a proximal humerus fracture may include:

• Severe shoulder pain.
• Swelling and bruising around the shoulder.
• Limited range of motion in the shoulder.
• Visible deformity in severe cases.

Diagnosis

Diagnosis typically involves:

• Physical examination: Assessing pain, swelling, and range of motion.
• Imaging studies: X-rays are the primary imaging modality used to confirm the fracture. CT scans or MRI may be used for more detailed evaluation.

Treatment

Treatment options depend on the severity and type of fracture:

• Non-surgical treatment: Includes immobilization with a sling or brace, followed by physical therapy.
• Surgical treatment: May be necessary for displaced fractures and can involve procedures such as open reduction and internal fixation (ORIF), hemiarthroplasty, or total shoulder arthroplasty.

Rehabilitation

Rehabilitation is crucial for recovery and typically involves:

• Physical therapy: To restore range of motion and strength.
• Occupational therapy: To assist with daily activities and improve functional use of the arm.

Prognosis

The prognosis for proximal humerus fractures varies based on factors such as age, overall health, and the severity of the fracture. Most patients recover well with appropriate treatment and rehabilitation, although some may experience long-term complications such as shoulder stiffness or arthritis.

Complications

Potential complications include:

• Nonunion or malunion of the fracture.
• Avascular necrosis of the humeral head.
• Nerve injury, particularly to the axillary nerve.

Prevention

Preventive measures include:

• Fall prevention strategies for the elderly.
• Use of protective gear during high-risk activities.
• Management of underlying conditions like osteoporosis.

See also

• Humerus
• Bone fracture
• Orthopedic surgery
• Shoulder joint