Proximal humerus fractures are fractures near the top of the upper arm bone. They commonly occur in older patients from falls and make up 4-5% of all fractures. Diagnosis is made using x-rays and sometimes CT scans. Treatment depends on the level of displacement but may involve non-operative methods like slings or operative techniques like plating or nailing. Early rehabilitation focusing on range of motion and strength is important to prevent stiffness and regain function. Complications can include stiffness, malunion, avascular necrosis, and heterotopic ossification.

1. Proximal Humerus Fractures
ALAM ZEB

2. Learning Objectives
•Bony and Muscular anatomy of the proximal
humerus
•Epidemiological factors and common mechanism
of injury for proximal humeral fractures
•Diagnostic tools
•Objective Examination
•Management
•Rehabilitation program
•Common complications

3. Bony Anatomy
􀁺 Humeral Head/Shaft
􀁺 Greater Tuberosity
􀁺 Lesser Tuberosity
􀁺 Surgical Neck
􀁺 Anatomical Neck

4. Muscular Anatomy
• Subscapularis attaches to lesser tuberosity
•Supraspinatus,Infraspinatus,Teres Minor
attaches to greater tuberosity
•Deltoid attaches to deltoid tuberosity
•Pectorolis Major attaches to
lateral lip of bicipital groove

5. Epidemiology
• 4-5% of all fractures
• 75% of humeral fractures in patients over 40
• Women incidence > Men
– osteoporotic factor
Mechanism of Injury
Over 50
– Minimal to moderate trauma
– More typically indirect mechanism such
as fall on an outstretched hand
 Under 50
– High-energy trauma
– More typically direct impact or fall on
the shoulder
– May be concurrent with dislocation due to higher
forces

6. Diagnostic Studies
X-ray (Trauma Series)
– A-P
– Lateral (Y-view)
– Axillary View
 CT Scan
– To determine fracture
alignment and
displacement

7. Objective Examination
• Varies related to type of fracture and amount
of displacement
• Painful motion
• Swelling and delayed ecchymosis
• Tenderness to palpation
• Crepitus indicative of fracture instability
• IR/ER to assess proximal and distal humerus
move simultaneously as a unit

8. General Treatment Options
Non-Operative
•80% of PHF are NONDISPLACED and can be successfully
treated NONOPERATIVELY
Operative
•20% of PHF are Displaced which can be
treated operatively and non-operatively.
it depends upon the fracture paterrn.
Operative Techniques used are :
- Percutaneous pinning
– Plates and screws
– Intramedullary rods
– Humeral head prosthesis

9. Operative Techniques

10. Rehabilitation
 Early and aggressive rehabilitation program designed to :
•Prevent stiffness and restore nomal ROM.
•Maintain normal relationship between head of
Humerus and gleniod cavity.
•Provide stability at Fracture site
•Regain strength of shoulder musles
• Rehabilitation exercise needs to begin within
14 days of injury to increase likelihood of
acceptable outcome and reduce chance for
motion complications

11. Typical Progression
Ist week:
•All shoulder movements are avoided
•Strengthening exercises are avoided
•Weight bearing is strictly prohibited
•Provide assistance in daily life activities
 Weeks 2-4:
•Pendulum exercises with sling are started
•Isometric shoulder exercises
•Weight bearing is prohibited
Weeks 4-8 :
•Perform active, active assisted and passive
ROM to shoulder and elbow
•Isometric and Isotonic exercise

12. Typical Progression

13. Common Complications
• Stiffness
• Non-Union or Malunion
• Avascular Necrosis
• Neurovascular Injury
• Myositis Ossificans