Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Pathological fracture of the humerus musculoskeletal key. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Proximal humeral fractures usually result from a fall on an outstretched arm. Fractures occurring at or proximal to the surgical neck of the humerus epidemiology. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients. Nerve lesions in proximal humeral fractures rijnland orthopedie. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. These fractures tend to occur in older patients who are osteoporotic. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of.
Fractures of the proximal humerus represent about 45 % of all fractures and are the third most common fractures in the elderly. Hemiarthroplasty, plate fixation, proximal humeral fracture, reverse arthroplasty, shoulder fracture view abstract download pdf. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Some 26% of proximal humerus fractures are associated with neurovascular injuries. Oct 01, 2010 introduction proximal humerus nonunions present a significant challenge for the surgeon. Proximal means it is the end of the bone that is closest to the body.
Non displaced 2 part fracture good alignment does not involve an articular surface. Proximal humeral fractures may be called a 2part, 3part or 4 part fracture depending on the amount of fragments fractured during the injury. Pdf proximal humerus fractures current treatment options. How much movement should be restricted following the fracture will depend on the severity of the break. Proximal humerus fracture classifications shoulderdoc. At this point, a hole periloc proximal humerus plate was applied to the humerus figure 3. Surgical technique locking proximal humerus plate depuy synthes 7 1. Conservative treatment, plate fixation, or prosthesis for. Good outcomes depend on detailed fracture evaluation, careful patient selection with thorough consideration of individual patient characteristics, comorbidities and functional expectations and advanced surgical expertise across a wide range of. After complete surgical removal r0 of a recurrent desmoidtype fibromatosis local radiotherapy with 60 gy was administered after repeated recurrence. Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. At this point, a hole periloc proximal humerus plate was. Proximal humerus fractures the hospital for sick children. Bony healing occurs usually within 6 to 8 weeks in adults 3.
The humeral head is covered in articular cartilage and articulates. The neer system divides the proximal humerus into for parts and considers not the fracture line, but the displacement as being significant in terms of classification. We will take xrays a couple of weeks after your injury, then get the shoulder moving to avoid stiffness of the shoulder joint. No pt for 3 weeks, unless otherwise specified by md. Proximal humerus fracture shoulder 7 fracture care team. The proximal humeral physis contributes approximately 80% of the growth of the humerus. Surgical neck junction of diaphysis and metaphysis. The fracture pattern most commonly associated with axillary nerve injury is an anterior fracture dislocation with a displaced greater tuberosity. If one structure is angulated or displaced, the fracture has 2 parts see figure one and 2part fractures of the proximal humerus. The neer classification for proximal humerus fractures is based on 4 fracture parts. Complications may include injury to an artery or nerve, and compartment syndrome. Epidemiology of proximal humerus fractures springerlink. A humerus fracture is a break of the humerus bone in the upper arm.
Humeroulnar articulation humeroradial articulation and. Proximal humeral fracture twin boro physical therapy. There are three main contributions to the vascular supply of the humeral head. Read online rehabilitation guidelines for proximal humerus fracture.
The glenohumeraljoint capsule is large enough to contaiii two. Most common fracture affecting the shoulder girdle in adults. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side. Nondisplaced means less than 1cm of displacement and less than 45. Proximal humerus shoulder fractures musculoskeletal. Nonoperative proximal humeral fracture rehabilitation protocol. Jan 12, 2014 surgical approaches to distal humerus fractures dr. There may be a decreased ability to move the arm and the person may present holding their elbow. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Only a few studies exist concerning traction injury of nerves in fractures of the proximal humerus after lowvelocity trauma. Many patients with proximal humerus nonunions present with significant scarring, failed instrumentation.
These forces may be compressive, tension, torsion or bending. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Oct 11, 2019 some 26% of proximal humerus fractures are associated with neurovascular injuries. The proximal humerus is important because it forms half of the shoulder joint. Fractures of the proximal humerus are common, accounting for 5% of all fractures. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Proximal humerus fractures are rare in paediatric traumatology.
Should this trend continue, the fracture rate would triple over the next three decades. The management of proximal humerus fractures in adults is a challenging and demanding task. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Evaluation and classification of proximal humeral fractures. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Proximal humerus fracture book twin cities orthopedics. Proximal humeral fracture radiology reference article. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. A distal humerus fracture affects the elbow and is a break in the lower end of the humerus. Through an integrated knowledge user collaboration, we sought to map the breadth of literature available to guide the management of proximal. The number and type of major fragments provide the name for these fractures.
Mar 02, 2017 a distal humerus fracture affects the elbow and is a break in the lower end of the humerus. Return to normal function and motion may require 3 to 4 months overall goals. We will take xrays a couple of weeks after your injury, then get the shoulder moving. The pdf of the article you requested follows this cover page. Almost 80% of proximal humeral fractures have only one part. Proximal humerus fractures trail behind only femoral neck and distal radius as the third most common fracture in patients older than 65 years.
In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation between 19% and 30%. More severe shoulder fractures may require surgery to realign and stabilize the injury. Cause of over 150,000 annual emergency department ed visits in the us. Surgical treatment of three and fourpart proximal humeral. They most commonly occur in the elderly and exhibit a female to male predominance of 24.
For complex and unstable fractures locking proximal humerus plate. Indirect forces transmitted through the proximal humerus and shoulder are the cause of most fractures. Bone quality osteoporosis increases the risk of comminution, reduction difficulties, and insecure fixation with disassembly of the construct or material migration through the humeral head. Reduce the head fragments and check the reduction under image intensi. Fractures of the proximal humerus in osteoporotic bone article pdf available in osteoporosis international 16 suppl 2s02. Nov 17, 2019 a proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Advocates of this technique cite the main advantage is the preservation of blood supply due to decreased soft tissue stripping, in addition to a more cosmetic scar and. A proximal humerus fracture is a break of the upper part of the bone of the arm. S6572 april 2005 with 3,575 reads how we measure reads.
The development and anatomy of the proximal humerus explain the various fracture types, displacements, and potential complications. Proximal humerus fracture epidemiology 65 third most common fracture after hip and distal radius. Minimally invasive treatment of proximal humerus fractures has become more prevalent in an effort to preserve the humeral head, but avoid the complications associated with orif. Proximal humerus fractures are the third most common. Metaphyseal fractures account for about 70% of cases and epiphyseal separation for the remaining 30%. Results the incidence of proximal humerus fractures is increasing. Courtbrown found that 70% of all 3 and 4part fractures are seen in patients aged over 60 years and 50% in patients aged over 70 years. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Although the fracture pattern is an important consideration when deciding upon treatment for and predicting the risk of osteonecrosis after proximal humeral fractures, other patientrelated factors contribute to the personality of the fracture. Proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. Precision preoperative planning is indicated for fracture reconstructions because many of the normal bony anatomical guidelines available to the surgeon have been either disrupted or distorted by the fractures. This is an enhanced pdf from the journal of bone and joint surgery.
Proximal humerus fractures pediatric orthopaedic society of. Humeroulnar articulation humeroradial articulation and radioulnar articulation. Most proximal humerus fractures are nondisplaced not out of position, but about 1520 percent of these fractures are displaced, and these may require more invasive treatment. Proximal humerus fractures are estimated to make up 5% of all fractures, making them the 3 rd most common adult fracture type. For example, if no structures are displaced or angulated, the fracture has one part. All books are in clear copy here, and all files are secure so dont worry about it. The fracture dislocation was reduced in the emergency room. These types of humerus fractures are most often caused by direct trauma and is commonly sustained in car. Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. Post fracture proximal humerus rehabilitation guidelines. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture.
Proximal humerus fractures in children and adolescents. Proximal humerus fracture you have a fracture break of your shoulder bone the proximal humerus. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. Increase rom while protecting the fracture site you can be slightly more. For complex and unstable fractures locking proximal. The most common twopart fracture is a humeral neck fracture, separating the head of the humerus from the shaft of the humerus shown in the picture above to the left.
Extension and internal rotation not performed until 6 weeks 4. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. A proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Dr balaji vinayaka mission kirubananda variyar medical college. Medical treatment for a proximal humeral fracture most often includes a period of immobilization using a sling, with the arm slightly abducted. There are only a few previous populationbased studies that include both inpatient and outpatient treatment data. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The elbow joint is a hinge joint and consists of three components. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. Plain films are usually sufficient to characterize proximal humeral fractures. Neer classification of proximal humeral fractures radiology.
Functional outcomes for surgically treated 3 and 4part. The fracture is actually at the top of the arm bone the humerus. Bone density is a predictor of reduction quality and can be. Theses fractures are increasingly common in the over 60s age group. Download rehabilitation guidelines for proximal humerus fracture. The four parts are the humeral head, the greater tuberosity, the lesser tuberosity and the humeral shaft. The aim of this study was to investigate the epidemiology of proximal humerus fractures. Fracture of the proximal humerus with loss of joint congruity. Interventions for proximal humerus fractures strengthening exercise. Patients should be seen in the fracture clinic or by an interested gp within 7 days for followup with x. Reduce fracture and fix temporarily proper reduction of the fracture is crucial for good bone healing and function. Functional bracing of fractures of the shaft of the humerus.
Complications of treatment of proximal humerus fractures. The axillary nerve is the nerve most commonly injured. Proximal humeral fracture postsurgical rehabilitation protocol. Management of proximal humeral fractures based on current. Pdf fractures of the proximal humerus in osteoporotic bone. In some cases closed reduction before prepping the patient is bene.
A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. In this age group most injuries are related to low injury falls. Bony healing occurs usually within 6 to 8 weeks in adults 2. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly. May 10, 2015 proximal humerus fractures are a common fragility fracture that significantly affects the independence of older adults. Surgical approaches to distal humerus fractures dr. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. How should this fracture b e treated in the emergency department girl under 10 years old or boy under 12 years old. Fracture proximal humerus 5% of all fractures of all the fractures of the proximal humerus. Tend to occur in older patients who are osteoporotic. Nov 18, 2014 the management of proximal humerus fractures in adults is a challenging and demanding task.