Proximal Humerus Fractures
Proximal humerus fractures are fractures that occur at the top of the humerus (arm bone), near the glenohumeral (shoulder) joint. These fractures occur during low energy falls in the setting of osteoporotic bone or high energy trauma in younger individuals.
Proximal humerus factures occur more commonly in women, and increasing age is associated with more complex fracture patterns. Concomitant injuries to surrounding nerves or arteries may occur and are more likely to result from a combined fracture-dislocation injury.
The Neer Classification accounts for “parts” based on anatomic relationships, specifically the greater tuberosity, lesser tuberosity, articular surface and the humeral shaft. A part is considered a separate part if it is displaced > 1 cm and/or angulated 45 degrees or more.
Signs and Symptoms
Pain and localized swelling occur, as well as decreased shoulder motion.
Physical Examination and Work-up
On examination, bruising may extend down the arm or to the chest. A careful neurovascular exam is essential to evaluate for nerve or vessel injury. There may or may not be associated rotator cuff tear.
X-rays are utilized to make the diagnosis of the proximal humerus fracture and help determine appropriate classification. CT scans allow for pre-operative planning and provide more information on intra-articular comminution. MRI is generally not needed but can assess for concomitant rotator cuff injury.
Management of Rotator Cuff Arthropathy
Sling immobilization, physical therapy, and activity modification are the first line treatment for some fracture types. Closed reduction percutaneous pinning or Open reduction internal fixation is indicated in progressively complex fracture types. Post-operative rehabilitation is closely monitored and guided with criterion-based advancement based on regular follow up visits.