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Proximal Humerus fractures

Your proximal humerus forms the ball of your shoulder’s 'ball and socket'.  It also serves as the attachment area for your rotator cuff tendons and tendons of other muscles in your shoulder girdle.

Fractures to your proximal humerus may follow a shoulder dislocation or a fall onto your shoulder or arm. They become more common as we get older as our bones become weaker.

When the proximal humerus breaks, the attached rotator cuff tendons often pull the fracture fragments in different directions to cause displacement.

A broken proximal humerus is generally very painful; patients develop significant bruising and swelling that can go into the chest as well as down the arm.

Sometimes nerves are damaged at the same time and this can cause numbness and weakness in the arm and shoulder region.

How is it diagnosed?

Your history and examination findings will be highly suggestive.  X-rays taken in the Emergency department will confirm the fracture.  Sometimes a CT scan is performed to assess more closely the displacement of the fracture fragments, damage to the articular surface and potential for surgical reconstruction.

Will I have to have an operation to fix my proximal humerus fracture?

Most proximal humerus fractures do not require surgery.   For many fracture patterns, the outcome of non-operative management is equivalent to the surgical outcome at two years after injury.  Unfortunately, however your injury is treated, proximal humerus fractures take a long time to get over (a year or so) – surgical fixation does not necessarily shorten this period.

Some fractures will however benefit from surgery. Factors that influence the decision to offer surgery include:

Your fracture pattern – (how many parts is it in? how displaced is it? where in the bone is the fracture?)

- Fractures can be described as 2,3 or 4-part depending on the position of the two tuberosities, the humeral head and the shaft.  

- In general, the more parts, the worse the injury, but some 2 part fractures also require surgery.

The quality of your bone and your rotator cuff (often age-related)

Your functional expectations (work/hobbies/sports etc) and physical health

Your surgeon will tell you if he thinks you should consider surgery and, if so, what is involved.

What will happen if I don’t have surgery?

You will be given a collar and cuff sling and advised to rest your shoulder. We will give you strong painkillers as your shoulder will be sore for some time. You be able to go home and be seen as an outpatient, typically at a week or two after injury.  Repeat x-rays will check your position – sometimes a decision is made at this point to operate.  Your worst pain should begin to settle after three weeks, but these first weeks are often very uncomfortable.

At six weeks, you can begin to move your shoulder more and you will be referred to physiotherapy. From three months, you can begin gentle resistance training if your x-rays show healing.