Proximal Humerus Fracture
The humerus is the long bone in your upper arm that connects to the shoulder joint. The upper end of this bone can break if trauma occurs to the shoulder. The bone can be broken in a few or several pieces, which can displace. Many of these fractures can be treated nonoperatively with a sling for a few weeks and physical therapy. When fractures are markedly displaced, surgery may be recommended to help optimize the function recovered after the injury.
- Upper arm/shoulder pain
- Bruising and swelling of the arm or shoulder
- Visible abnormal contour of upper arm
- Decreased range of motion and strength
- Non-operative - Most fractures can be treated with conservative treatment. This involves immobilizing the injured shoulder for 6-8 weeks in a sling. The sling is usually removed starting in 1 week for elbow, wrist, and finger range of motion. Pendulum exercises start at 2 weeks, and formal physical therapy typically starts at 4 weeks depending on how the bone is healing. Fractures take 6-8 weeks to heal, but the bone will continue to remodel for up to 2 years. Physical therapy will help regain range of motion and strength and restore the shoulder mechanics. Several months of PT are usually required.
- Surgery - There are several factors that are considered when considering surgery. If the fracture is markedly displaced or if the patient desires a quicker initial recovery, surgery is often recommended. Dr. Faulkner also considers several factors on the x-rays when making this determination. If the fracture is irreparable because it is in multiple pieces or because of poor bone quality, a reverse shoulder replacement may be required. In this case, the pieces of bone attached to the rotator cuff muscles are preserved and secured to the prosthesis. This surgery is associated with good outcomes for restoring functional range of motion without pain.
Usually this is diagnosed by x-rays obtained at an emergency room or urgent care. When being evaluated in clinic, x-rays are often repeated to make sure the fracture has not moved from the initial radiographs, which can frequently occur. If the fracture is in multiple pieces, a CT scan may be ordered to evaluate the fracture in more detail and for preoperative planning.
The location of the fracture, the number of broken pieces, and the amount of shifting of the fracture fragments from the anatomic position are important factors that are considered when determining the best treatment plan. Additionally, the patient’s age, activity level, and functional demands are also considered.
The most common risks are stiffness, persistent pain, weakness and delay to more use of the arm. Additionally, with nonoperative treatment the bone can shift, leading to abnormal alignment of the bone called a malunion.