Fractures of the proximal humerus are common, accounting for 5% of all fractures. These fractures tend to occur in older patients who are osteoporotic.
The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. In younger patients, high-energy trauma is the cause of injury.
The treatment objective in proximal humerus fractures is to allow bone and soft tissue healing in a normal anatomical position to maximise function of the upper extremity.
Most fractures are minimally displaced and stable, so surgical fixation is not required. A supportive sling followed by early rehabilitation and have good functional outcomes.
The greater tuberosity is the prominent area of bone at the top of the humerus and is the attachment for the two large, powerful rotator cuff muscles- supraspinatus and infraspinatus.
It is injured/fractured in a fall by either landing directly onto the side of your shoulder or landing with your arm outstretched. It may fracture alone, or with other injuries of the shoulder joint (commonly a shoulder dislocation or complex humeral fracture).
As greater tuberosity fractures are usually retracted posteriorly and superiorly, a closed reduction is difficult. If left in position, impingement will develop against the acromion, limiting elevation and external rotation of the shoulder. However if the fracture is associated with anterior dislocation then a closed reduction of the glenohumeral dislocation may successfully reduce the greater tuberosity fracture, and once it has healed, recurrent anterior instability is unlikely.
Hemiarthroplasty is a shoulder replacement where the broken humeral head is replaced with an artificial joint and the fractured bone reconstructed around the artificial joint.
This is performed when the fracture is severely displaced. The blood supply to the humeral head is damaged and it is at risk of eroding if repaired. The head is therefore replaced, rather than repaired. This is more commonly performed in elderly people.
Proximal Humeral Fractures:
Fractures of the proximal humours are common, accounting for 5% of all fractures. These fractures tend to occur in older patients who are osteoporotic. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. In younger patients, high-energy trauma is the cause of injury.
Most clavicle fractures are mainly treated in a sling for about 4-6 weeks. Clavicle braces may provide more comfort if applied correctly and align some fractures in a more stable position.
However complete healing can be slow and may take up to 3-6 months. After 6 months about 15% of clavicle fractures still may have not healed. This is known as a “nonunion”.
Early fixation of clavicle fractures has some advantages, such as: