Proximal humerus fracture discharge care what you need. Classification this information is current as of january 22, 2009 reprints and. Patients should be seen in the fracture clinic or by an interested gp within 7 days for followup with x. Nonoperative proximal humeral fracture rehabilitation protocol general principles.
The major muscles that move the arm the rotator cuff. Intramedullary nail for treating proximal humerus fractures. The aim of this study was to investigate the epidemiology of proximal humerus fractures. Proximal means it is the end of the bone that is closest to the body. Fractures involving the attachments of the rotator cuff. In our experience, proximal humerus allograft re construction was associated with a high complication rate and resulted in multiple revision procedures in. To evaluate the clinical effectiveness of surgical vs nonsurgical treatment for adults with displaced fractures of the proximal humerus involving the surgical neck. The trigen humeral nail provides new possibilities for the treatment of proximal humeral fractures and humeral shaft fractures. Locking plate fixation for proximal humerus fractures. Plating system, optilock proximal humeral plates are intended to address complex fractures of the proximal humerus. Open subtypes 3 open subtypes 3 your digital gateway to expertise, education, and. The patient also had a history of metastatic prostate cancer. Increase rom while protecting the fracture site you can be slightly more.
Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. Bring the fractured proximal humeral shaft into the wound by removing the bolster and extending the arm in slight adduction. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Proximal humerus fractures are rare in paediatric traumatology. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments, such as those between the coracoid process of the scapula and the acromion, stabilize the glenohumeral. Pdf arthroplasty for proximal humerus fractures grant.
Its upper surface is rounded and marked by three flat impressions. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. This injury occurs right where the arm bone humerus connects with the shoulder blade scapula to form the shoulder joint. Proximal humerus fracture management linkedin slideshare.
The need for surgery for the majority of patients with displaced proximal humeral fractures is unclear, but its use is increasing. Ruler for expert humeral nail parallel to the humerus so that the proximal locking slot symbolized on the ruler is located at the correct point against the proximal humerus. Surgical technique locking proximal humerus plate depuy synthes 9 3. Open reduction and internal fixation orif with lockedplate constructs has shown some promise, but it has been fraught with complications. Non displaced 2 part fracture good alignment does not involve an articular surface. Proximal humeral fxs majority occur in the elderly, minimally displaced and stable. Medical treatment for a proximal humeral fracture most often includes a period of immobilization using a sling, with the arm slightly abducted. However, every individual is different, and you should ask as many questions as you like. 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. The shoulder is a ball and socket joint and you have fractured the ball part. How much movement should be restricted following the fracture will depend on the severity of the break. Approximately 19 628 health workers became infected during the execution of their duties. Interventions for proximal humerus fractures strengthening exercise. Optilock upper extremity plating system proximal humeral plates.
Pediatric proximal humerus fractures are a relatively common physeal and metaphyseal fracture of the proximal humerus seen in children with a peak age of 15 year of age. Proximal humerus fractures by krr linkedin slideshare. This plate addresses complex fractures of the proximal humerus. Extension and internal rotation not performed until 6 weeks 4. The proximal humerus is the top portion of the humerus upper arm bone. Schwartz, md clinical professor chief orthopedic trauma university of california, san diego. The humerus is the second most common site for long bone metastases following the femur. In addition, simple range of motion exercises such as pendulum swings and wall walkups should be encouraged and can be quickly demonstrated in the ed. Common causes of a proximal humerus fracture include. Patients should be made aware that about 90% of recovery of the shoulder from proximal humerus fractures occurs in the first 34 months and the remaining 10% takes 6 months or longer much longer than other major joints in the body 7. 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. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Maintain range of motion rom without displacing the proximal humerus fracture.
Functional bracing of fractures of the shaft of the humerus. Salter type 3 fractures of the proximal humerus are rare injuries. Mark the skin over the proximal humerus at the top of the nail symbolized on the ruler. This information will guide you through the next 6 weeks of your rehabilitation.
In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone after hip fractures and wrist fractures. Post fracture proximal humerus rehabilitation guidelines. The upper part of the humerus forms part of the shoulder joint and the lower part of the bone helps form part of the elbow joint. They usually result from trauma in individuals this age. Rehabilitation is central to addressing the problems caused by the fracture. In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation between 19% and 30%. Left proximal humerus and humeral shaft biopsy left humeral shaft case background information 61yearold lefthand dominant male who had a fall at work resulting in a left proximal humerus fracture with extension into the humeral shaft figure 1.
Most recently, reverse total shoulder arthroplasty rtsa has emerged as a possible surgical solution. Shoulder trauma fractures and dislocations orthoinfo aaos. Proximal humerus fracture shoulder 7 fracture care team. The pdf of the article you requested follows this cover page.
A proximal humerus fracture is a crack or break in the top of your upper arm bone. A proximal humerus fracture is sometimes referred to as a a broken shoulder or a broken arm. To the editor on 23 april 2020, the national health institute reported 177 143 confirmed cases and more than 23 188 confirmed covid19 deaths affecting italy. Humerus the long head of the biceps tendon and the lesser tuberosity are retracted anteromedially while the greater tuberosity is retracted posteriorly. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. For complex and unstable fractures locking proximal humerus plate.
Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. It features the next generation in humeral plating, offering the surgeon. Fractures of the proximal humerus are an increasingly common injury, accounting for 4% to 5% of all fractures 1,2 and 45% of all humeral fractures. Proximal humerus fractures in children and adolescents. We report the first case of a salter type 3 physeal fracture with posterior dislocation of the proximal humerus in a 16yearold boy. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. The humeral head is covered in articular cartilage and articulates moves against with the socket of the shoulder joint, the glenoid. 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. Orif of fracture proximal humerus youve been listed for an operation orif open reduction and internal fixation of the proximal humerus the top end of your arm bone. Epidemiology of proximal humerus fractures springerlink. More severe shoulder fractures may require surgery to realign and stabilize the injury. Proximal humerus bone fractures overview verywell health.
Fracture proximal humerus 5% of all fractures of all the fractures of the proximal humerus. The purpose of this study was to provide a guideline of normal mri developmental anatomy of the proximal humerus in a growing child. In 82 cases a nonsurgical treatment desault bandage in 11 cases, hanging cast in nine cases, closed reduction and shoulder spica cast in 62 cases was performed. Electrotherapy or hydrotherapy does not enhance recovery. All books are in clear copy here, and all files are secure so dont worry about it. Proximal humerus fracture is often seen in elderly population 1 and postmenopausal female. 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. Surgical technique proximal humeral fracture plate system. Especially common in elderly individuals due to osteoporosis, proximal humerus fractures are among the most common broken bones in the shoulder. The shoulder joint is essentially a ball and socket joint.
The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral shoulder joint figure 1 and figure 2 and figure 3. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 3 april 2015 v1s. Risk factors o between ages 1116 average 14 age when proximal humeral physeal growth is at its peak o overhead sports baseball, tennis, volleyball, swimming. Download rehabilitation guidelines for proximal humerus fracture. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm.
There are only a few previous populationbased studies that include both inpatient and outpatient treatment data. Jul 15, 2012 proximal humerus fracture management 1. Each of these plates is anatomically sidespecific, e. The most common location of proximal fractures is at the surgical neck of the humerus. The integra proximal humeral fracture plate system is designed for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus.
Proximal humerus fractures commonly occur in patients over age 65 especially women secondary to a fall on an outstretched had the presence of displacement, defined as fractures with greater than 1 cm of displacement and less than 45 degrees of angulation, often determines operative versus nonoperative management plan. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Proximal humerus fracture east sussex healthcare nhs trust. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser. The fall doesnt need to be from any great height, falling from a standing height. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Neer, ii and evaluation displaced proximal humeral fractures. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am.
Metaphyseal fractures account for about 70% of cases and epiphyseal separation for the remaining 30%. Shoulder dislocations can involve any of the three different joints that make up the shoulder. We will take xrays a couple of weeks after your injury, then get the shoulder moving to avoid stiffness of the shoulder joint. Sling immobilization with or without closed reduction also has a role in the management of displaced proximal humerus fractures. These plates are low profile, stainless steel and available in 2hole 75mm, 4hole 99mm, 6hole 123mm and 10hole 171mm lengths. Broken shoulder proximal humerus fracture bone talks. Healy and colleagues 1 reported on the outcome of 25 proximal. Proximal humeral fracture twin boro physical therapy. 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. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. The shoulder is a ball and socket joint and you have fractured just below the ball part.
Shoulder trauma fractures and dislocations orthoinfo. Fractures of the proximal humerus in children springerlink. Nov 18, 2014 the management of proximal humerus fractures in adults is a challenging and demanding task. Longterm survival of proximal humerus allografts for reconstruction. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. The development and anatomy of the proximal humerus explain the various fracture types, displacements, and potential complications. P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial. The proximal humerus is one of the bones in your shoulder joint. This information aims to help you understand your condition and gain maximum benefit from your treatment. This normally takes between 612 weeks to unite heal. Read online rehabilitation guidelines for proximal humerus fracture. Return to normal function and motion may require 3 to 4 months overall goals. Proximal humeral fracture surgery in the covid19 pandemic.
Bony healing occurs usually within 6 to 8 weeks in adults 2. Proximal humerus fracture you have a fracture break of your shoulder bone the proximal humerus. Proximal humerus fracture book twin cities orthopedics. Dislocated two, three, and fourfragment fractures of the proximal humerus, including fractures involving osteopenic bone pseudoarthroses in the proximal humerus. Evaluation and management of pediatric proximal humerus fractures. Proximal humerus fractures account for a majority of fractures of the upper arm and 5% of all fractures. Position plate the proximal humeral locking plate is usually positioned 5 mm caudal to the proximal end of the greater tuberosity and 10mm dorsal to the posterior border of the intertubercular sulcus. The most common cause of a proximal humerus fracture is falling over onto an outstretched hand. Challenges of proximal humerus fractures alexandra k. Retrospective interpretation of 83 consecutive mri studies of shoulders in children 2 months to 17 years old was performed in consensus by two radiologists. Oct 01, 2010 an analysis of the literature reveals few published series on the results of surgical treatment for nonunions of the proximal humerus. The fracture is actually at the top of the arm bone the humerus. The incidence of proximal humerus fractures is 4% to 5% of 1all fractures.
You should have received most of the information during your last consultation with me. Your pain does not get better or gets worse, even after you rest and take medicine. Fractures of this region are common both with highenergy. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures.
Humeral headsplit fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint. Proximal humerus fracture is quite a common injury among elderly population who. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Treatment is nearly always nonoperative in younger patients due to the remodeling potential of the proximal humerus. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients. A proximal humerus fracture is a common injury to the shoulder.
Surgical vs nonsurgical treatment of adults with displaced. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Optimal treatment in elderly patients remains controversial, and an evidencebased approach is critical to improve patient outcomes and allocate limited health care resources 1 4. Stable proximal humerus fracture rehab protocol introduction this protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Among proximal fractures, 80% are onepart, 10% are twopart, and the remaining 10% are three and fourpart. Occult shoulder injuries and proximal humerus fractures. Nov 17, 2019 a proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Bony healing occurs usually within 6 to 8 weeks in adults 3. Proximal humerus fractures are the third most common fragility fracture and they are associated with a substantial burden of disability and impaired quality of life.
Shoulder fractures most often involve the clavicle collarbone, proximal humerus top of the upper arm bone, or the scapula shoulder blade. The proximal humerus is important because it forms half of the shoulder joint. Proximal humeral epiphysiolysis little league shoulder. If a fracture or fracture repair is stable, then therapy should be started early. The profher proximal fracture of the humerus evaluation by randomization study 3 is a pragmatic randomized controlled trial conducted in 33 centers with 66 surgeons including senior residents. Skeletal development of the proximal humerus in the pediatric. Jun 24, 2008 ninetyone children who had been treated for fractures of the proximal humerus 59 metaphyseal fractures. The most useful rehabilitation protocol is the threephase system. A proximal humerus fracture is a break of the upper part of the bone of the arm. Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The fracture is also observed in children mostly following fall and young adults following direct impact, which results in fracture.
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