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Proximal Humerus Fracture – Causes, Symptoms & Treatment

A proximal humerus fracture is a break at the upper end of the arm bone. It is one of the most common fractures, especially in older adults with reduced bone density.

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Things worth knowing about "Proximal humerus fracture"

A proximal humerus fracture is a break at the upper end of the arm bone. It is one of the most common fractures, especially in older adults with reduced bone density.

What is a Proximal Humerus Fracture?

A proximal humerus fracture (also called a humeral head fracture) is a break at the upper end of the upper arm bone (the humerus), which forms the shoulder joint. It accounts for approximately 5% of all fractures and is one of the most common fractures in the human body. The condition predominantly affects people over the age of 60, as bone density decreases with age, a condition known as osteoporosis. Women are affected more often than men.

Causes

The most common cause of a proximal humerus fracture is a fall onto an outstretched arm or directly onto the shoulder. Other possible causes include:

Falls from height
Road traffic accidents
Sports injuries (e.g., skiing or horse riding accidents)
Forceful twisting or overstretching of the shoulder joint
Pathological fractures due to pre-existing bone conditions (e.g., osteoporosis or bone metastases)

Symptoms

Following a proximal humerus fracture, the following symptoms typically occur:

Severe pain in the shoulder and upper arm area
Swelling and tenderness around the shoulder
Bruising (haematoma) that may spread to the upper arm or chest
Restricted movement of the shoulder joint, sometimes a complete inability to move the arm
In rare cases: tingling or numbness due to involvement of nerves or blood vessels

Diagnosis

Diagnosis is made through a combination of clinical examination and imaging:

X-ray: Standard X-rays of the shoulder in at least two planes are taken to assess the fracture.
Computed Tomography (CT): In complex fractures, CT provides detailed three-dimensional information about the position of bone fragments and is essential for surgical planning.
Magnetic Resonance Imaging (MRI): Used when soft tissue injuries, ligament damage, or vascular involvement are suspected.

The Neer classification is commonly used to categorise the fracture based on the number of displaced fragments (1- to 4-part fracture), guiding treatment decisions.

Treatment

Conservative Treatment

Non-displaced or minimally displaced fractures (approximately 80% of all cases) can generally be managed conservatively. The arm is immobilised using a supportive arm sling or brace (such as a Gilchrist sling) for several weeks. Pain management and early physiotherapy exercises to prevent shoulder stiffness are key components of conservative treatment.

Surgical Treatment

Severely displaced, unstable, or multi-fragment fractures require surgical intervention. Depending on the fracture type and the age of the patient, various procedures may be used:

Plate osteosynthesis: Stabilisation of bone fragments using a metal plate and screws
Intramedullary nailing: Insertion of a nail into the bone canal to provide stability
Shoulder joint replacement (prosthesis): In severely comminuted fractures or when blood supply to the humeral head is compromised, a partial or total shoulder replacement may be necessary (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder prosthesis)

Aftercare and Rehabilitation

Post-treatment rehabilitation is critical for functional recovery and includes:

Physiotherapy to restore range of motion and muscle strength
Pain management
Regular X-ray follow-ups to monitor bone healing
Treatment of underlying osteoporosis to prevent future fractures

Depending on fracture severity and treatment method, bone healing generally takes 6 to 12 weeks, while full rehabilitation may take several months.

References

Lill H, Scheibel M, Voigt C (eds.): Die Humeruskopffraktur. Springer-Verlag, Berlin/Heidelberg, 2010.
Neer CS 2nd: Displaced proximal humeral fractures. Part I: Classification and evaluation. Journal of Bone and Joint Surgery Am. 1970;52(6):1077–1089. PubMed PMID: 5455339.
Handoll HH, Brorson S: Interventions for treating proximal humeral fractures in adults. Cochrane Database of Systematic Reviews. 2015;(11):CD000434. DOI: 10.1002/14651858.CD000434.pub4.

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