What is a Proximal Humeral Fracture?

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  • What is a Proximal Humeral Fracture?

The humerus is the bone between the shoulder and the elbow. The proximal humerus is the upper part of the bone near the shoulder. A proximal humeral fracture is common, especially in the elderly with osteoporosis (brittle bones).

If the fracture occurs in the elderly, it is usually caused by falling from ground level on an outstretched arm (low-energy fall). Having osteoporosis also increases the risk of a fracture. If the fracture occurs in young people, it is usually caused by high-energy trauma, such as falling from a high level or traffic accidents. In these cases, there may also be injury to the nerves, blood vessels and tissue surrounding the fracture.

What should I do if there is a fracture?

Signs of a fracture include

  • Pain and swelling in the area
  • Inability to raise the arm
  • The arm may appear deformed

You should avoid moving your arm. You should seek medical treatment immediately.

How is a Proximal Humeral Fracture diagnosed?

A fracture is usually diagnosed through an X-ray. During an X-ray, electromagnetic waves are used to look at the structure of the bones, which can help the doctor determine if it is broken or not. Although the patient is exposed to some radiation, it is very minimal.

The doctor may also test if you have your sense of touch or are able to move your hand to ensure that the nerves and blood vessels near the fracture are not damaged.

How is the fracture treated?

The method of treatment depends on what type of fracture and how severe it is. For example, if the broken part of the bone is out of place or the bone is shattered into 3 or more pieces, surgery may be required to put the bone back in place so that it can grow back in the correct position. If surgery is not required, you may need to wear a cast for several weeks.

Surgical treatment of such fractures can consist of either fixation with plate and screws or with metal rods placed in the bone. The choice of the technique depends on factors such as the type of fracture, and the age of the patient, amongst others.

In severe cases, especially in fractures involving older patients, partial or reverse total joint replacement may also be an option.

For normal shoulder replacements, the top of the humerus bone is still the ball while the shoulder is the socket. For reverse total shoulder arthroplasty, the roles of the ball and socket are reversed.

Reverse total shoulder arthroplasty is performed in order to compensate for poor muscle function in older patients.

Physical therapy sessions may also be involved in treatment to help the patient recover mobility in the arm and shoulder through light exercises. It usually takes a few months for the bone to completely heal.

For an assessment of your condition, please book an appointment with Dr. Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology