Fractures are commonly seen around the shoulder joint region. In younger adults, they are usually the result of high-energy trauma. Falls from bicycles and motorcycles are often associated with shoulder injuries. In elderly patients with osteoporotic bones, simple falls may be associated with shoulder fractures.
The severity of shoulder fractures varies greatly. In younger patients with high-energy injuries, there is often significant comminution (fracturing into many pieces of bone) at the fracture site.
The proximal humerus is made up of four main structural components. The humeral head consists of a sphere that is covered with articular cartilage to form the joint surface. There are two 'tuberosities' at the neck of the humerus. These are bony prominences onto which tendons from the rotator cuff attach. The fourth component of the proximal humerus is the humeral shaft itself.
Commonly patients will separate the four different components of the proximal humerus to varying degrees. In some cases, patients may have a simple impaction fracture where the head of the humerus is pushed or impacted onto the shaft. These fractures are often quite stable and may not require any intervention.
Treatment
With non-displaced tuberosity fragments, a period of immobilisation in a sling may be all that is required.
In highly displaced fractures with high-energy trauma, open reduction and internal fixation is often required. The aim of surgery is to reduce the humeral head into the correct alignment and secure it to the shaft of the humerus. The tuberosity fragments must also be reduced into position and secured.
Recovery
Following this type of injury, the recovery can be prolonged. The fracture usually starts to show signs of healing within a six-week period. It can easily take three or four months for the fracture to fully heal.
One of the biggest difficulties following a proximal humeral fracture, is regaining the range of movement. Patients will usually require quite extensive physiotherapy to try and maximise their outcome.
Each case is unique in relation to the fracture pattern and the quality of the bone. The rate at which recovery can progress will depend upon the stability of the fixation that can be achieved.
In many instances, there will be a gradual increase in the range of movement over the first 6 to 12 months following a proximal humerus fracture.