Proximal humerus fractures occur just below the ball and socket joint of the shoulder. There is a wide spectrum of injury in terms of severity and complexity with these injuries. Fractures may involve the articular surface of the ball and socket joint, the bony prominences where the rotator cuff tendons attach to the arm or sometimes be associated with a dislocation of the shoulder joint.
Proximal humerus fractures can occur in younger patients as the result of a major trauma such as a car or motorbike accident. More often, however, they are the result of a simple fall from standing height in a more elderly patient and in this circumstance often indicate the presence of osteoporosis (brittle bones).
Exactly how your proximal humerus fracture is best managed will depend on a number of factors. Because of the vast range of motion in the shoulder joint, small changes to the alignment of your fracture may be well compensated without any loss of function and for this reason many simple fractures are managed without surgery and achieve reliably good outcomes. For more complex injuries, a CT scan (3D x-ray) may be performed to allow more thorough analysis of your injury.
Surgery for Proximal Humerus Fractures
What type of surgery is performed for proximal humerus fractures will depend on your particular fracture pattern. Some fractures predominantly affecting the rotator cuff attachments can be treated just like a rotator cuff tear and are often able to be treated with arthroscopic (key-hole) surgery alone.
More complex fractures that can be reconstructed will often require a plate and screws to be inserted to hold the fracture aligned while it heals. Often this is also combined with suture fixation for the rotator cuff bony fragments to restore normal balance and function to the shoulder.
Rehabilitation after this type of surgery is a balance of protecting the repair and fixation that has been performed whilst also getting the shoulder moving to prevent longer term stiffness that can be quite functionally disabling. Your physio will guide you through this balancing act in conjunction with Dr Alexander.
Certain proximal humerus fractures are deemed ‘unfixable’ due to fracture complexity, bone quality or predicted poor vascularity (blood supply) to the humeral head. In well-selected patients with this type of injury, reliable results can be achieved with reverse shoulder replacement surgery. Whilst this may seem like a quick fix, there is still considerable rehabilitation required to maximise your result after this kind of surgery, and certain activities will require lifelong modification to extend implant longevity.