The Proximal Humerus is divided into 4 parts namely :
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), but about 15-20% of these fractures are displaced and these may require more invasive treatment.
1. Surgical neck : most common
2. Greater Tuberosity
3. Anatomical neck
4. Lesser Tuberosity : uncommon
These fractures account for approximately 20% of Proximal Humeral Fractures.
1. Greater tuberosity and shaft are displaced with respect to the lesser tuberosity and articular surface which remain together. Most common three part pattern.
2. Lesser tuberosity and shaft are displaced with respect to the greater tuberosity and articular surface which remain together.
These fractures account for approximately 5% of proximal humeral fractures.
This pattern has poor non-operative results and as the articular surface is no longer attached to any parts of the Humerus which are attached to soft tissues, it has a high incidence of osteonecrosis. These fractures require operative management.
About 80% of Proximal Humerus Fractures are non-displaced (not out of position) and these can almost always be treated in a sling. 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 (out of position), it may be necessary to realign or replace the damaged bone. Determining the best treatment depends on many factors including :
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 by either pins, screws, wires, large sutures or a plate will be used to hold the bones in place.
If there are concerns about repairing the bone, it may be decided to perform some type of Shoulder Replacement. If a replacement procedure is recommended, options include a standard shoulder replacement, a hemiarthroplasty, or a reverse Shoulder Replacement