Proximal Humerus Fractures

Overview:

Proximal humerus fractures are breaks in the upper part of the arm bone near the shoulder. They are common in young people with high-energy injuries and older adults with low-energy falls.

What is the Proximal Humerus?

The proximal humerus is the upper section of the arm bone that connects to the shoulder joint.    

Causes of Proximal Humerus Fractures:

• High-Energy Trauma:'Car accidents, sports injuries, or falls from height (more common in young people).
• Low-Energy Falls:'Simple falls, often due to osteoporosis (more common in older adults).

Symptoms:

• Pain:'Severe pain at the shoulder.
• Swelling and Bruising:'Visible swelling and discoloration around the shoulder.
• Limited Movement:'Difficulty moving the arm.

Diagnosing Proximal Humerus Fractures:

• Physical Examination:'Checking for pain, swelling, and deformity.
• Imaging:
  • X-rays:'Standard views to assess the fracture.
  • CT Scans:'Detailed images for complex fractures.

Types of Fractures:

• Neer Classification:'Based on the number of fracture parts and their displacement.
• AO Classification:'Detailed classification considering the fracture pattern.

Treatment Options:

1. Non-Surgical Management:
   • Suitable for minimally displaced and stable fractures.
   • Pain Management:'Medications to control pain.
   • Immobilisation:'Using a sling to support the arm.
   • Rehabilitation:'Gradual exercises to restore movement and strength.
2. Surgical Management:
   • Needed for displaced or unstable fractures.
   • ORIF (Open Reduction and Internal Fixation):'Aligning and fixing the bones with plates and screws.

 

• Intramedullary Nailing (IM):Inserting a rod into the bone to stabilize the fracture.

    Arthroplasty:'Joint replacement surgery for severe fractures     Post-Operative Rehabilitation:

• Initial Immobilization:'Using a sling.
• Gradual Exercises:'Starting with gentle movements and progressing to strengthening exercises.
• Full Recovery:'Typically within 12 weeks.

Possible Complications:

• Non-Union:'Bone fails to heal.
• Malunion:'Bone heals incorrectly.
• Infection:'Risk after surgery.
• Hardware Issues:'Problems with surgical implants.

Lessons Learned:

• Accurate diagnosis and imaging are essential.
• Non-surgical treatment works for less severe fractures.
• Surgery is necessary for more complex fractures.
• Understanding the injury helps in choosing the right treatment.
• Post-operative rehabilitation and follow-up are vital for recovery and preventing complications.

  Proposed treatment algorithm for management of proximal humerus fracture. GT = greater tuberosity, LT = lesser tuberosity, ORIF = open reduction and internal fixation, CT: computed tomography; RSA = reverse shoulder arthroplasty. '