Proximal Humerus Fracture
Which Bone is Fractured?
What parts of the shoulder are most commonly fractured?
While any bone in the shoulder can be fractured, the bone most commonly fractured is the clavicle. (See Chapter 11.) The next most common shoulder bone fractured is the ball (proximal humerus). The least common shoulderbone fractured is the shoulder blade (scapula).
Which fractures will heal without surgery?
In general, if the fracture has not displaced from its normal position or is minimally displaced, the fracture can be treated in a sling, and it will heal on its own.
The one exception to this is for elderly patients, who have fractured a hip or leg and the shoulder. In this case, surgery for the shoulder fracture may be needed to help them get out of bed and use a walker or crutch. When surgery is needed, what will be done? Three types of fractures in the shoulder usually need surgery.
First is a fracture of the bone to which the rotator cuff tendons attach (greater or lesser tuberosity). When these fractures are displaced, the rotator cuff function is in jeopardy. These are usually treated by sewing the piece or pieces back in position. Some of these can be performed with arthroscopic assistance. Sometimes, these are fixed with pins or a screw.
Second is a displaced fracture of the surgical neck. If the humeral shaft and ball are out of alignment or not in at least 50-percent contact, the bone may heal in a bad position or not heal at all. These are usually fixed with a plate and screws or pins.
Third is a fracture that displaces the joint surface. A fracture of the ball (humeral head) that is displaced can severely affect how the shoulder works and can lead to deterioration of the joint. Some of thesefractures can be fixed with a plate and screws. Some require a partial joint replacement.
Assessing a Proximal Humerus Fracture
When the bone of the proximal humerus (ball) breaks, there are four things that are important to assess.
- First, which part or parts of the bone have been injured?
- Second, are those injured parts displaced from their normal position?
- Third, do any of the injured parts have rotator cuff tendons attached
- Fourth, is there a fracture that involves the joint surface?