A common and consequential injury
Proximal humeral fractures, meaning breaks of the upper end of the arm bone near the shoulder, are common. They can cause significant pain and loss of function if they are not treated effectively, which is why the detail of how they are assessed and fixed matters.
Who they happen to
These fractures occur in two broadly different groups. In older people they often follow a fall from standing height onto the arm or shoulder, where reduced bone density means a relatively modest injury breaks the bone. In younger people they usually require considerably more force, such as a fall from a height, a motorcycle accident or a sporting collision, and are more often associated with other injuries.
Why treatment varies so much
Proximal humeral fractures range from a single crack with the bone still in good position through to the upper humerus breaking into several separate fragments. Many are treated without surgery, in a sling, with movement started under guidance once the fracture is stable enough. Others are better fixed, and a smaller number, particularly where the blood supply to the head of the humerus is compromised or the bone is too fragmented to hold screws, are better treated with a reverse total shoulder replacement.
The decision rests on the fracture pattern, how displaced the fragments are, the quality of the bone, the age and general health of the patient, and what the arm is needed for. Getting that decision right is a large part of the outcome.
A course on fracture fixation
A few months before this post, Dr Cutbush attended a Medartis course in Sydney on fixation of these fractures, and found it a worthwhile exercise.
The format was a practical one. The course used pre-fractured specimens, which the attending surgeons then fixed in the laboratory. Each specimen was CT scanned after the fracture had been created, and X-rays were taken of each specimen after it had been fixed. Comparing the post-fixation X-rays against the pre-fixation CT scans gave a direct view of what had actually been achieved, which helped in understanding the fracture patterns themselves and how best to fix them.
Related information
See our pages on shoulder injuries, shoulder anatomy and shoulder surgery, and the rehabilitation page for what recovery involves. To arrange an assessment, see the consultation page.