Proximal humerus fractures can occur after trauma or falls, especially in older people with osteoporosis. Non-displaced fractures can be treated with immobilization, while displaced fractures may require surgery such as open reduction or hemiarthroplasty. Physical therapy is important for recovery.
A proximal humerus fracture is a break in the long bone of the upper arm at the shoulder joint. In a young person, this type of break can occur after a major trauma to the shoulder. Most commonly, a proximal humerus fracture can occur after a fall in an older person with osteoporosis.
During bone development, four growth plates form at the end of the humerus at the shoulder joint. These plates are originally made of cartilage and give the bone flexibility and allow it to grow in length. As the humerus bone reaches maturity, growth plates solidify into the bone. They are, however, liable to fracture if the patient falls and lands on his outstretched hand.
The injured patient would usually have pain and swelling in the shoulder following a proximal humerus fracture. The patient’s history and a description of the fall or trauma would give the doctor an indication of a fracture. Radiographs at different angles would be needed to confirm the diagnosis. A computed tomography (CT) scan may also be done to give a better view of the fracture.
The growth plates of the humerus divide the proximal end of the shoulder into four parts: the humoral head, the greater tubercle, the lesser tubercle, and the shaft or shaft. Most fractures of the proximal humerus are considered non-displaced, meaning that none of these four sections were separated by more than 0.39 inch (1 cm). Nondisplaced fractures are usually treated by immobilizing the arm in a sling for 7 to 10 days. This allows gravity to hold the humerus in the correct position. Bone healing should begin in three to six weeks.
If any of the four end regions of a shoulder fracture is separated by more than 0.39 inch (1 cm), it is called a compound fracture. Displaced fractures are classified as two-, three-, or four-part fractures. In a two-part fracture, two different parts of the end region of the humerus would have been broken apart.
Most two- and three-piece fractures are treated surgically. The surgeon may perform an open reduction, which means that an incision is made in the shoulder and the bone fragments are reduced or pushed back into their original position. The bone fragments are then fixed in place with pins, screws or plates.
Serious four-part fractures also need to be treated surgically, but the surgeon may choose to perform a hemiarthroplasty. A hemiarthroplasty is a procedure in which the shoulder joint is replaced by an artificial metal joint that extends into the empty space in the center of the humerus. The joint is then sutured to the bone to hold it in place.
Physical therapy is an important part of healing following a proximal humerus fracture. Range of motion exercises are usually started two weeks after surgery. For a complete recovery, the patient will have to engage in therapy and work closely with the doctor.
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