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Proximal Humerus Fracture

→ a breakage in the uppermost section of the arm bone.

What is the proximal humerus?

The humerus is the uppermost bone of the arm, running from shoulder to elbow. On the shoulder side, the bone ends in the humeral head – the smooth, half-spherical ‘ball’ of the ball-and-socket joint (or glenohumeral joint). Just below the humeral head is the anatomic neck, and below that are two sections known as the greater and lesser tubercles. Together, these four components form the proximal humerus.

How does the proximal humerus fracture?

Most commonly, it happens when we stretch out a hand to break the impact of a fall: the force travels up the arm to its furthest point and causes the proximal humerus to break. It can also occur during a direct-impact injury, such as a sudden blow to the shoulder in sport. One or several parts of the proximal humerus may be affected (so fractures are defined as 1-part, 2-part, 3-part or 4-part). While proximal humerus fractures can happen to anybody, they are most common in the elderly, and more common in women than men. Fractures in older patients tend to happen as the bones lose strength with age; they are especially common in the case of osteoporosis (a disease that causes the bones to become generally weaker). The majority of proximal humerus fractures are what surgeons call ‘non-displaced’ – that is, the bones remain in their correct position. Around one in five fractures, however, become displaced, or misaligned. These kinds of fractures can be more complicated to treat.

How is a proximal humerus fracture diagnosed?

The symptoms of this kind of fracture can include pain in the shoulder accompanied by swelling and bruising. It may also result in reduced arm movement and numbness in the arm or hand. In the case of a displaced fracture, there may also be a visible deformity of the bone. You may also be asked to have an x-ray or MRI scan to help with the diagnosis.

What happens next?

Depending on the degree and severity of the injury, treatment for a proximal humerus fracture varies from non-surgical to surgical intervention. Non-surgical treatment might include pain relief and immobilization (such as with a sling) while the fracture heals. This may be accompanied by physical therapy and a programme of exercises as the injury settles. Surgical procedures vary quite significantly depending on the type of injury sustained; this will be discussed with you in detail at the clinic.