Shoulder Fractures – Proximal Humerus Fractures

What is a proximal humerus fracture?

A proximal humerus fracture is a common type of shoulder fracture. Fractures are broken bones. Minor fractures are small cracks in the bone that are hard to spot on an X-Ray. In severe fractures, the bones may break completely or shatter into many pieces.

A proximal humerus fracture occurs close to the shoulder joint on the humerus. The humerus is the bone that runs from your shoulder and shoulder blade to your elbow.

What causes a proximal humerus fracture?

Falls, accidents or injuries usually cause proximal humerus fractures.

Common causes of these fractures include:

• Falling on an outstretched hand – the fracture occurs when you use your hand to break a fall from a standing position
• A high-impact accident – forceful trauma, such as a car crash or sporting injury like a rugby tackle, can also cause a fracture.

Proximal humerus fractures tend to be more common in older people with weak bones (conditions known as osteoporosis or osteopenia). People with weak bones have a higher risk of fractures and their bones are more likely to break during everyday activities.

How do I know if I have a proximal humerus fracture?

If you have a proximal humerus fracture, you will usually notice the following signs and symptoms near your shoulder:

• Pain
• Swelling
• Bruising
• Tenderness

You may be unable to move your shoulder completely. If you can move your shoulder, you may feel like the bones are loose or grating. Severe fractures can make the shoulder look out of place. Some people also get nerve damage that affects the normal movement of the arm.

What are the treatment options for proximal humerus fractures?

There are several different treatment options for proximal humerus fractures, including surgery, limited movement and physiotherapy. All forms of treatment aim to hold your broken bone in place until your bone has completely healed.

The treatment that best suits your fracture will depend on factors such as:

• The location of fracture
• The severity of the fracture
• Your age and how healthy you are.

If you have a mild fracture, or if your bone fragments have not moved out of position, you may not need surgery. Your treatment program will involve limiting the movement of your shoulder and physiotherapy. You will need to wear a sling, brace or splint. You will also need to keep your shoulder in a fixed position for several weeks. After that, you can start gentle exercises that will help to increase your shoulder’s range of motion.

Recovery is a balancing act. Be mindful that doing too many exercises may displace your fracture further yet avoiding exercise altogether can cause a stiff shoulder.

If your fracture is complex or bone fragments have moved out of their normal position, you may need surgery. There are different surgery options, and your surgery will depend on the location and seriousness of the fracture. Dr Chia will guide you on the most suitable treatment options.

Surgery options for proximal humerus fractures include:

• Percutaneous fixation – your surgeon corrects the fracture then inserts pins to hold the fracture in position until the bone has healed
• Plate osteosynthesis – a plate is screwed over the fracture and fixed with screws
• Intramedullary nail fixation – a nail or rod is placed in the centre of the bone
• Shoulder replacement – the damaged part of the bone, called the humeral head, is replaced with an artificial (prosthetic) humeral head.

Dr Chia will talk to you about the available options and develop a personalised treatment plan, including treatment, rehabilitation and follow-up care. You’ll need to carefully follow your treatment program to give your fracture the best chance of healing and avoid further injury.