Extension and internal rotation not performed until 6 weeks 4. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients. For complex and unstable fractures locking proximal humerus plate. Cause of over 150,000 annual emergency department ed visits in the us. Proximal humerus shoulder fractures musculoskeletal. The management of proximal humerus fractures in adults is a challenging and demanding task. How much movement should be restricted following the fracture will depend on the severity of the break. There are only a few previous populationbased studies that include both inpatient and outpatient treatment data. Conservative treatment, plate fixation, or prosthesis for. Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults.
Surgical approaches to distal humerus fractures dr. Proximal humeral fracture postsurgical rehabilitation protocol. For example, if no structures are displaced or angulated, the fracture has one part. In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation between 19% and 30%. Bone quality osteoporosis increases the risk of comminution, reduction difficulties, and insecure fixation with disassembly of the construct or material migration through the humeral head.
There may be a decreased ability to move the arm and the person may present holding their elbow. Theses fractures are increasingly common in the over 60s age group. For complex and unstable fractures locking proximal. The development and anatomy of the proximal humerus explain the various fracture types, displacements, and potential complications. We will take xrays a couple of weeks after your injury, then get the shoulder moving. Proximal humerus fracture classifications shoulderdoc. Read online rehabilitation guidelines for proximal humerus fracture. No pt for 3 weeks, unless otherwise specified by md. Proximal humerus fractures pediatric orthopaedic society of. Pdf fractures of the proximal humerus in osteoporotic bone. Fracture of the proximal humerus with loss of joint congruity.
As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. This is an enhanced pdf from the journal of bone and joint surgery. Metaphyseal fractures account for about 70% of cases and epiphyseal separation for the remaining 30%. The most common twopart fracture is a humeral neck fracture, separating the head of the humerus from the shaft of the humerus shown in the picture above to the left. Minimally invasive treatment of proximal humerus fractures has become more prevalent in an effort to preserve the humeral head, but avoid the complications associated with orif. Proximal humerus fracture shoulder 7 fracture care team. The proximal humerus is important because it forms half of the shoulder joint. Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. The axillary nerve is the nerve most commonly injured. These fractures tend to occur in older patients who are osteoporotic. Plain films are usually sufficient to characterize proximal humeral fractures. After complete surgical removal r0 of a recurrent desmoidtype fibromatosis local radiotherapy with 60 gy was administered after repeated recurrence. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Proximal means it is the end of the bone that is closest to the body.
In this age group most injuries are related to low injury falls. The fracture is actually at the top of the arm bone the humerus. They most commonly occur in the elderly and exhibit a female to male predominance of 24. Should this trend continue, the fracture rate would triple over the next three decades. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Fractures occurring at or proximal to the surgical neck of the humerus epidemiology. Evaluation and classification of proximal humeral fractures. Return to normal function and motion may require 3 to 4 months overall goals.
The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. Nov 18, 2014 the management of proximal humerus fractures in adults is a challenging and demanding task. At this point, a hole periloc proximal humerus plate was applied to the humerus figure 3. Mar 02, 2017 a distal humerus fracture affects the elbow and is a break in the lower end of the humerus. Oct 11, 2019 some 26% of proximal humerus fractures are associated with neurovascular injuries. Oct 01, 2010 introduction proximal humerus nonunions present a significant challenge for the surgeon. Indirect forces transmitted through the proximal humerus and shoulder are the cause of most fractures. More severe shoulder fractures may require surgery to realign and stabilize the injury. Proximal humerus fractures in children and adolescents. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. A distal humerus fracture affects the elbow and is a break in the lower end of the humerus. Proximal humerus fractures the hospital for sick children. How should this fracture b e treated in the emergency department girl under 10 years old or boy under 12 years old.
A proximal humerus fracture is a break of the upper part of the bone of the arm. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly. The proximal humeral physis contributes approximately 80% of the growth of the humerus. These forces may be compressive, tension, torsion or bending. We will take xrays a couple of weeks after your injury, then get the shoulder moving to avoid stiffness of the shoulder joint. Reduce fracture and fix temporarily proper reduction of the fracture is crucial for good bone healing and function. Surgical technique locking proximal humerus plate depuy synthes 7 1. Nerve lesions in proximal humeral fractures rijnland orthopedie. In some cases closed reduction before prepping the patient is bene. These types of humerus fractures are most often caused by direct trauma and is commonly sustained in car.
The neer classification for proximal humerus fractures is based on 4 fracture parts. The fracture dislocation was reduced in the emergency room. Almost 80% of proximal humeral fractures have only one part. The four parts are the humeral head, the greater tuberosity, the lesser tuberosity and the humeral shaft. There are three main contributions to the vascular supply of the humeral head. Fractures of the proximal humerus in osteoporotic bone article pdf available in osteoporosis international 16 suppl 2s02. Surgical neck junction of diaphysis and metaphysis. Proximal humerus fracture epidemiology 65 third most common fracture after hip and distal radius. Functional outcomes for surgically treated 3 and 4part. Management of proximal humeral fractures based on current. Hemiarthroplasty, plate fixation, proximal humeral fracture, reverse arthroplasty, shoulder fracture view abstract download pdf.
Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. Medical treatment for a proximal humeral fracture most often includes a period of immobilization using a sling, with the arm slightly abducted. Pdf proximal humerus fractures current treatment options. Bony healing occurs usually within 6 to 8 weeks in adults 2. Proximal humerus fracture you have a fracture break of your shoulder bone the proximal humerus. Fractures of the proximal humerus are common, accounting for 5% of all fractures. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. The fracture pattern most commonly associated with axillary nerve injury is an anterior fracture dislocation with a displaced greater tuberosity.
Most proximal humerus fractures are nondisplaced not out of position, but about 1520 percent of these fractures are displaced, and these may require more invasive treatment. Nonoperative proximal humeral fracture rehabilitation protocol. Nonoperative proximal humeral fracture rehabilitation protocol general principles. The aim of this study was to investigate the epidemiology of proximal humerus fractures.
The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Tend to occur in older patients who are osteoporotic. Dr balaji vinayaka mission kirubananda variyar medical college. Proximal humerus fractures are the third most common. Neer classification of proximal humeral fractures radiology. If one structure is angulated or displaced, the fracture has 2 parts see figure one and 2part fractures of the proximal humerus. Some 26% of proximal humerus fractures are associated with neurovascular injuries. Humeroulnar articulation humeroradial articulation and. Patients should be seen in the fracture clinic or by an interested gp within 7 days for followup with x. Jan 12, 2014 surgical approaches to distal humerus fractures dr. Many patients with proximal humerus nonunions present with significant scarring, failed instrumentation. Bone density is a predictor of reduction quality and can be. Advocates of this technique cite the main advantage is the preservation of blood supply due to decreased soft tissue stripping, in addition to a more cosmetic scar and.
Symptoms include pain, swelling, and a decreased ability to move the shoulder. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. May 10, 2015 proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. At this point, a hole periloc proximal humerus plate was. Reduce the head fragments and check the reduction under image intensi. The number and type of major fragments provide the name for these fractures. The elbow joint is a hinge joint and consists of three components. Proximal humeral fractures usually result from a fall on an outstretched arm.
Fracture proximal humerus 5% of all fractures of all the fractures of the proximal humerus. Proximal humerus fracture book twin cities orthopedics. A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. Bony healing occurs usually within 6 to 8 weeks in adults 3. Only a few studies exist concerning traction injury of nerves in fractures of the proximal humerus after lowvelocity trauma.
Functional bracing of fractures of the shaft of the humerus. Proximal humerus fractures trail behind only femoral neck and distal radius as the third most common fracture in patients older than 65 years. Interventions for proximal humerus fractures strengthening exercise. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. The pdf of the article you requested follows this cover page. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. A humerus fracture is a break of the humerus bone in the upper arm. Proximal humeral fractures may be called a 2part, 3part or 4 part fracture depending on the amount of fragments fractured during the injury. Non displaced 2 part fracture good alignment does not involve an articular surface. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Proximal humeral fracture twin boro physical therapy.
A proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Download rehabilitation guidelines for proximal humerus fracture. Courtbrown found that 70% of all 3 and 4part fractures are seen in patients aged over 60 years and 50% in patients aged over 70 years. Proximal humeral fracture radiology reference article. Nondisplaced means less than 1cm of displacement and less than 45. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of. Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Pathological fracture of the humerus musculoskeletal key. All books are in clear copy here, and all files are secure so dont worry about it. Post fracture proximal humerus rehabilitation guidelines.
Epidemiology of proximal humerus fractures springerlink. Complications may include injury to an artery or nerve, and compartment syndrome. Proximal humerus fractures are estimated to make up 5% of all fractures, making them the 3 rd most common adult fracture type. Humeroulnar articulation humeroradial articulation and radioulnar articulation.
Increase rom while protecting the fracture site you can be slightly more. Nov 17, 2019 a proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Proximal humerus fractures are rare in paediatric traumatology. Surgical treatment of three and fourpart proximal humeral. The neer system divides the proximal humerus into for parts and considers not the fracture line, but the displacement as being significant in terms of classification. Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The glenohumeraljoint capsule is large enough to contaiii two. Good outcomes depend on detailed fracture evaluation, careful patient selection with thorough consideration of individual patient characteristics, comorbidities and functional expectations and advanced surgical expertise across a wide range of. Fractures of the proximal humerus represent about 45 % of all fractures and are the third most common fractures in the elderly. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of proximal. Although the fracture pattern is an important consideration when deciding upon treatment for and predicting the risk of osteonecrosis after proximal humeral fractures, other patientrelated factors contribute to the personality of the fracture. Complications of treatment of proximal humerus fractures. Most common fracture affecting the shoulder girdle in adults. S6572 april 2005 with 3,575 reads how we measure reads.
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