Proximal Humerus Fracture.
A proximal humeral fracture refers to a break in the bone involving the area just below the humeral head, which is commonly known as the ‘ball’ of the shoulder’s ball-and-socket joint. This is a relative weak point in the bone, therefore any severe force on the shoulder, such as falling onto the shoulder or falling on an outstretched arm can cause the bone to break into multiple pieces. A proximal humerus fracture can greatly affect the shoulder joint and upper arm movement in the long term. Early expert assessment is highly recommended to maximise you future function.
How is a proximal humerus fracture diagnosed?
Following an injury, pain, difficulties lifting the arm, severe bruising, swelling and a bump or deformities around the shoulder are all common symptoms. The majority of patients attend A&E straight away where the fracture is diagnosed.
X-rays can be obtained on the day of your consultation and will demonstrate the fracture pattern and the amount of displacement of the bone fragments. At a later stage of the injury, x-rays are very useful for monitoring fracture healing.
CT scans are usually required to assess in more detail the pattern of injury. They are also very useful if surgery is needed as they allow Mr Moverley to accurately plan your procedure.
Treatment options
Mr Moverley will tailor your treatment specifically to which parts of the bone are broken and the displacement of the fragments, whilst taking into account your expectations and medical history.
Non-operative Management
Unless your proximal humerus fracture is associated with a nerve or blood vessel injury it is usually possible to manage these fractures without surgery. Approximately 80% of patients with proximal humerus fractures do not require surgery. If the fracture is undisplaced (the broken pieces are still touching) then non-operative treatment is highly recommended.
Possible non-operative options include:
A Sling to support the injured shoulder and prevent movement at the fracture site, this may be needed for up to 6-8 weeks. A sling also provides excellent pain relief in the early stages after the injury. As pain decreases with time it is a good sign that the broken bone is starting to heal, at this stage the sling can be used less.
Putting an ice pack on the injured area for 15-20 minutes may help reduce swelling, bruising, and pain.
Simple pain killers may help reduce pain and swelling.
Limiting certain activities such as lifting or driving, or movements such as reaching and pulling until the bone has healed.
A focused physiotherapy program to stretch the soft tissues around the shoulder and to strengthen the muscles will help improve strength, flexibility, and range of motion in the injured arm and shoulder.
Smoking greatly reduces the likelihood of your proximal humerus fracture healing.
If you do smoke you should try and quit immediately. https://www.livewelldorset.co.uk/stop-smoking/
How successful is non-operative treatment of proximal humerus fractures?
In some cases, treating proximal humerus fractures without surgery can result in complications; including shoulder stiffness, post traumatic arthritis of the joint and long-term poor function of the shoulder.
Less common but more serious complications include your fracture failing to heal and bone death caused by avascular necrosis (an insufficient blood supply). If the fractured upper arm bone is immobilized for too long, you may develop a Frozen shoulder (very stiff shoulder).
Surgical Management
Mr Moverley will discuss if surgery is necessary for your proximal humerus fracture in the following cases:
Dislocated fractures, in which the humeral head (the ball) has dislocated from the shoulder socket.
Open fractures, in which the bone penetrates the skin.
Injuries to surrounding blood vessels and nerves.
Humeral head-split fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint.
Widely displaced fractures in younger or high demand patients