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Proximal humerus fractures
Orthopedic care you can trust
Proximal humerus fracture is a common injury to the shoulder especially among elderly individuals due to osteoporosis.
A proximal humerus fracture occurs when the ball, of the ball-and-socket shoulder joint, is broken. The fracture is actually at the top of the arm bone (the humerus). Most proximal humerus fractures are non-displaced (not out of position).
The most significant problem with proximal humerus fractures are the treatment is very limiting, and the outcomes are often fair or poor. Many patients who sustain this injury do not regain full strength or mobility of the shoulder, even with proper treatment.
Treatment of Proximal Humerus fracture
Typical treatment is to rest the shoulder in the sling for 2-3 weeks, and then begin some gentle range of motion exercises. As healing progresses, more aggressive shoulder strengthening exercises can resume, and full healing typically takes about 3 months. In more severe injuries where the bone is displaced, it may be necessary to realign or replace the damaged bone. Determining the best treatment depends on many factors including:
- Age of the patient
- Hand dominance
- Activity level of the patient
- Degree of displacement of the fracture
Surgical treatment of Proximal Humerus Fractures
The options for surgery include realigning the bone fragments and holding them in position with metal implants, or a shoulder replacement procedure is performed..
If the fragments of bone can be fixed, either pins, screws, wires, large sutures , or a plate will be used to hold the bones in place.
If a replacement procedure is recommended, options include a standard shoulder replacement, a hemiarthroplasty, or a reverse shoulder replacement..
The specific recommendation for which type of surgery is best depends on many factors including the type of break and the specific patient..
For example, reverse shoulder replacements can be excellent treatments but are reserved for elderly, less-active patients..
Complications that may arise
Declines in shoulder function are not uncommon, and people who sustain these injuries often do not recover their full strength or mobility of the joint.
Because of the trauma to the shoulder joint, the development of early arthritis is a common complication of these injuries.
Some of the complications directly related to surgical treatment of proximal humerus fractures include infection, wound healing problems, nerve injury, and lack of healing of the bone.
Metal hardware used to repair a broken bone is not meant to be a permanent solution, rather it holds the bone in place while healing takes place. If the bone does not heal completely, then the metal implants will eventually fail, and usually, repeat surgery needs to be considered.
