The proximal humerus is the part of your arm bone (humerus) nearest to the shoulder.  These injuries are common in patients with soft bone (osteopenia and osteoporosis), but can also occur in patients without osteopenia who have sustained a high-energy injury (car accident, skiing, etc.).  Twice as common in women.

Fractures of the proximal humerus are classified as either 2-part, 3-part, or 4-part depending on how many fragments there are.  The most common are the 2-parts with a fracture line between the shaft and the head or a fracture line separating the greater tuberosity (the part of the proximal humerus where the rotator cuff attaches) from the rest of the humerus.

X-rays can diagnose these fractures, but a CT scan is commonly performed to evaluate the fracture lines and plan for surgery.  An MRI is rarely indicated because when the energy of the injury causes a fracture it usually dissipates and does not also cause a rotator cuff tear.

TREATMENT:

Nonoperative – Most proximal humerus fractures can be treated non operatively as they are minimally displaced and will heal well.

Operative – Surgical fixation is indicated when the fractures are displaced and if heal in that displaced position will lead to a dysfunctional surgery with limited range of motion and strength.  Surgical options include pinning, plates and screws, a nail, and in the case of fractures that are not repairable a partial or full shoulder replacement.  A shoulder replacement would be either a hemiarthroplasty (partial replacement of just the head) or a reverse total shoulder.

My preferred treatment method:  I have performed both the nailing technique and a plate and screw construct fixation successfully and the individual technique is individually based upon fracture type.  Most patients who undergo surgery are discharged the same-day in an outpatient setting with the exception generally being if a replacement was performed.  

FAQs:

  1. I have a proximal humerus fracture, do I need surgery? – The approach is very individualized and needs to be evaluated on a case-by-case basis depending on activity level and fracture type in clinic with an orthopedic surgeon.
  2. How long is recovery? – Bones take 6-8 weeks to heal but generally a full recovery of range of motion and strength can take up to a year.
  3. Can I ever get back to my old activities like golfing, skiing, and weightlifting? – This is again individualized based upon the surgical procedure necessary, but generally my goal is to get you back to your baseline activity level with limited restrictions.