Humerus fracture

Proximal Humerus Fracture

Background

• Typically occur in elderly osteoporotic pts from FOOSH mechanism
• Must rule-out axillary and brachial plexus neurovascular injuries
• Greater tuberosity fx suggests rotator cuff tear
• Lesser tuberosity fx suggests posterior shoulder dislocation

Clinical Features

• Pain, swelling, tenderness about the shoulder
• Arm is held closely against chest wall

Imaging

• AP, lateral, and axillary radiographs
• Fx of articular surface suggested by pseudosubluxation:
  • • Superior joint hematoma pushes humerus down

Management

• Guided by the Neer System
  • Proximal humerus is divided into four "parts" based on epiphyseal lines:
    • Articular surface of humeral head
    • Greater tubercle
    • Lesser tubercle
    • Shaft of humerus
  • A "one-part" fx is one in which fragment is displaced <1cm or not angulated >45deg
• "One-part" fracture
  • Sling and swathe, ice, ortho referral
• >One-part fractures
  • Ortho consult in the ED

Source

• Tintinalli