Proximal humerus fracture


  • 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



Refered pain & non-orthopedic causes:


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

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" fracture 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