A proximal humerus fracture is a break in the upper end of the upper arm bone, at or near the shoulder joint. It is one of the most common fractures in adults over 65 and a frequent high-energy injury in younger patients. Treatment ranges from sling immobilization for minimally displaced fractures to complex reconstruction for comminuted patterns.
What Is a Proximal Humerus Fracture?
The proximal humerus has four anatomic parts: the humeral head, the greater tuberosity, the lesser tuberosity, and the shaft. The rotator cuff tendons attach to the greater and lesser tuberosities. When the bone breaks, any combination of these parts can separate from the others, and the displacement pattern determines both the injury severity and the treatment approach.
Fractures are classified by the number of displaced parts. One-part fractures have minimal displacement. Two-part fractures involve one displaced segment. Three- and four-part fractures involve progressively more displaced segments, with four-part fractures carrying the highest risk of avascular necrosis of the humeral head from disrupted blood supply.
Causes and Risk Factors
- Ground-level fall onto an outstretched arm in older adults with osteoporotic bone
- High-energy trauma in younger patients from falls from height, motor vehicle collisions, or sport
- Shoulder dislocation, which often produces a greater tuberosity avulsion fracture
- Seizures, which produce posterior dislocations with lesser tuberosity or humeral head fractures
- Osteoporosis and other conditions that weaken bone
Symptoms
- Immediate pain and swelling at the shoulder
- Bruising that often extends down the arm and into the chest wall
- Inability to lift or rotate the arm
- Visible deformity in severely displaced fractures
- Numbness or tingling if the axillary nerve is injured
Diagnosis
Dr. Chudik’s evaluation begins with the mechanism of injury and a focused neurovascular examination. The axillary nerve is the most commonly injured nerve in proximal humerus fractures. X-rays in true AP, scapular Y, and axillary views define the fracture pattern. CT is added for surgical planning when displacement is significant or the pattern is complex. The Westmont office has on-site high-field MRI and X-ray, which allows many acute fractures to be evaluated the same day.
Treatment
Approximately 80 percent of proximal humerus fractures are minimally displaced and treated non-surgically with a sling, early pendulum exercises within the first week, and progressive range of motion as pain allows.
Surgical treatment is indicated for significantly displaced fractures, three- and four-part patterns, and fractures associated with dislocation. Dr. Chudik’s surgical options include Arthroscopic Proximal Humerus Greater Tuberosity Fracture Repair, a technique he developed to repair greater tuberosity fractures arthroscopically where conventional treatment requires open surgery; open reduction and internal fixation with a locking plate for displaced three- and four-part fractures; and reverse total shoulder arthroplasty for comminuted four-part fractures in older patients with poor bone quality.
Recovery and Outcomes
Non-surgical treatment typically requires two to three weeks in a sling, progressive motion from two weeks onward, and strength recovery over three to six months. After arthroscopic greater tuberosity repair or open fixation, a typical timeline includes four to six weeks of sling protection, passive motion starting within days, active motion at six weeks, and strengthening at three months. Stiffness is the most common complication across treatment types, and early motion protocols mitigate it.
When to See Dr. Chudik
Schedule an evaluation after any shoulder injury that produces immediate pain, inability to lift the arm, significant bruising, or visible deformity, especially after a fall. Call 630-324-0402 or request an appointment online.