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
Prox humerus fracture.jpeg

Clinical Features

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

Differential Diagnosis

Humerus Fractures

Humeral anatomy

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Diagnosis

  • AP, lateral, and axillary radiographs
  • Fracture 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
  • More than one-part fractures:
    • Ortho consult in the ED

See Also

References