Proximal Humerus Fracture
What is it: A fracture of the humerus bone.
How does it present: Proximal humerus fractures usually occur in older individuals and are often caused by a fall on an outstretched hand.
Common exam findings: Patients will often experience swelling, bruising and tenderness to palpation of the upper arm. They also tend avoid shoulder movement. Proximal humerus fractures can be associated with axillary nerve injuries, brachial plexus injuries, and radial nerve injuries. Proximal humerus fractures can disrupt blood supply to the humeral head and cause avascular necrosis. Fractures around the bicipital groove can affect the function of the tendon of the long head of the biceps. Undertake a neurovascular exam to evaluate for the full range of potential injuries. Because the axillary nerve provides sensation to the area over the deltoid, evaluate this carefully during the neurologic exam.
Tests and treatment: X-rays are needed to evaluate for the fracture. There are many types of fracture patterns and and fracture classification systems. The Neer system is the most commonly used and divides the proximal humerus into four parts. Most non-displaced one-part fractures can be treated conservatively (sling/swath - or - collar/cuff sling) to allow for gradual range of motion. Fractures involving the humeral neck are at high risk of avascular necrosis and should be managed with orthopedics. Orthopedics should also handle fractures that involve multiple parts of the proximal humerus, displaced fractures, and those associated with shoulder dislocation.