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

Differential Diagnosis

Humerus Fracture Types

Humeral anatomy

• Adult
  • Proximal
  • Shaft
  • Distal
    • Capitellum
    • Trochlea
    • Condylar
• Pediatric
  • Proximal
  • Shaft
  • Distal
    • Supracondylar
    • Lateral epicondyle
    • Medial epicondyle

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
• More than one-part fractures:
  • Ortho consult in the ED

See Also

• Humerus Fracture (Peds)
• Fracture (Main)

Source

• Tintinalli