Proximal Humerus Fracture

I had an accident and broken the head of my humerus (proximal humerus)

The head of the humerus is the ball part of the shoulder joint, which is a ‘balland-socket’ joint. There are several possible fracture configurations and depending on the fracture site and type, your injury can be treated conservatively or might require surgical fixation. Regardless, you might find yourself in an emergency department, suffering from pain and information overload and need some guidance and care. Please feel free to get in touch (07 3394 4073) and we will endeavour to look after you acutely. Should you happen to be at Greenslopes Private Hospital Emergency Centre ask your treating doctor to notify us. This is a straight forward referral process and Dr Rhau is often able to see you on short notice.

What are the symptoms of proximal humerus fracture?

Pain and inability to move the arm next to swelling are symptoms of proximal humerus fracture.

Who gets a proximal humerus fracture?

The humerus is the upper arm bone and the third largest in the human body. ‘Proximal’ means close to the centre of the body and therefore the proximal humerus forms part of the shoulder joint. A fall on the outstretched arm is the most common mechanism of injury and happens frequently in the older population where bone softening (osteoporosis) is present. Direct trauma to the shoulder as well as shoulder dislocations can also cause proximal humerus fracture. In the younger population theses injuries are often expressions of a hight energy trauma.

How is proximal humerus fracture diagnosed?

The injury or accident history will give the first clue. The physical examinations often reveals deformity, swelling and bruising. X-ray, CT scan and MRI scan are used for imaging.

Treatment for proximal humerus fracture

The proximal humerus has several parts. These are humeral head, anatomical and surgical neck, greater and lesser tuberosity. The possibilities of injuries to the proximal humerus are plentiful and correct diagnosis with adequate imaging studies is imperative in order to make the right management decision. A lot of theses fractures can be treated non operative with sling immobilisation and physiotherapy. Some fracture configurations require surgical fixation to restore normal anatomy and facilitate the best possible recovery while others might be better treated with partial or total joint replacement.

Surgery for proximal humerus fracture

The individual type of surgery for proximal humerus fracture depends heavily on the fracture configuration and involvement of different parts (humeral head, anatomical and surgical neck, greater and lesser tuberosity, humerus shaft). Most of them require an open approach for reduction of fragments and stabilisation with plate and screws. In cases where fixation is not possible a partial or total joint replacement might be the better choice for the best possible outcome.

Preparing for surgery for proximal humerus fracture

Prior to the procedure, we will arrange for one preconditioning physiotherapy session where we fit a shoulder immobiliser, explain some simple exercises and give you an ice bladder with icing instructions. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details.

Recovery from surgery for proximal humerus fracture

After surgical fixation sling immobilisation is recommended for roughly six weeks. Physiotherapy can commence within a few days following the procedure mainly for elbow and wrist motion. Once comfortable gentle exercises for the shoulder joint will commence. The surgical incision will be closed with internal sutures and the wound will have healed when you will have your scheduled two week postoperative appointment with me. X-ray will follow at the six week mark before sling immobilisation can be discontinued. This marks a change in rehabilitation where the focus will shift towards increasing range of motion and strength. Strength & resistance training will be initiated between the 3 and 6 months mark after surgery. You can expect and improvement in strength and range of motion for 12 to 18 months.