There are three bones that make up your shoulder – the shoulder blade, collarbone and upper arm bone (humerus). Falling onto an outstretched arm is a common cause of proximal humerus fractures, which are fractures of the humerus close to the shoulder joint. A humerus shaft fracture occurs lower down your arm in the mid portion of the upper arm bone.
Causes of proximal humerus fractures
Proximal humerus fractures are often seen in older people and women, particularly those with osteoporosis. In younger patients, a proximal humerus fracture is normally associated with high-impact trauma, such as a car accident or fall from a height.
Symptoms of proximal humerus fracture
The symptoms can vary depending on the type and severity of the fracture but they typically include: pain, swelling and bruising, deformity of the shoulder and upper arm, inability to move the shoulder, weakness or loss of function in the arm, and bleeding if the skin is broken.
Types of proximal humerus fracture
You may experience a simple or a comminuted fracture. The latter is where the bone has broken into three or more pieces with fragments of bone at the fracture site.
Treating a proximal humerus fracture
If the fragments of bone are not displaced, most proximal humerus fractures can be treated without surgery. However, if there is significant displacement (i.e. the pieces of bone are quite far away from each other) or there is a large amount of communition (many pieces of bone), then surgery may be necessary.
Surgical repair of proximal humerus fractures
There are different surgical approaches to repairing a proximal humerus fracture. Internal fixation involves setting the bones in the correct position and securing them in place to allow the bone to heal and grow back together. The surgeon may use metal plates, screws, pins or wires to hold the bone in place, which may remain in situ or be removed once the bone has healed. Alternatively, you may be offered a shoulder replacement if the fracture cannot be repaired, which involves removing the damaged joint altogether and replacing it with an artificial implant.
Bone grafts for severe proximal humerus fractures
In the case of complex proximal head fractures where the bone is severely displaced, you may need a bone graft. This is where the orthopaedic surgeon inserts additional bone tissue to rejoin the fractured pieces of bone. The repaired pieces are then held in place using internal fixation while the bone regrows.
Bone for grafting is normally taken:
- From within your own body, normally the top of the hip bone.
- From an external donor
Synthetic bone substitutes
Alternatively, the surgeon may use artificial bone. These synthetic bone substitutes are normally made from calcium compounds which are available in various forms that can be placed or injected into the fracture site. This material is slow to biodegrade, has superior strength in compression and can grow host bone to interdigitate with a rough crystalline graft interface. More liquid grafts are particularly effective at filling bone voids which often occur around the ball of the shoulder with a proximal humerus fracture.
Possible complications of proximal humerus fractures
When you fracture your proximal humerus, you may sustain damage to the surrounding tendons, nerves and blood vessels. If the bones are not correctly aligned, they may heal incorrectly (malunion) or fail to grow back together fully (nonunion). Occasionally after surgery an infection can occur, or the blood flow to the ball of the shoulder becomes interrupted and the shoulder loses its shape, leading to stiffness and arthritis.
If you fracture your shoulder, we can provide a diagnosis and recommend the most appropriate treatment plan to support healing and restore function to your shoulder. Contact us for more details.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).
Telephone: 020 376 15987
Email: admin@thamesshoulderandelbow.co.uk
Our Locations
Hospital of St John and St Elizabeth, St John’s Wood – Directions
BMI The Syon Clinic, Brentford – Directions
HCA Chiswick Medical Centre, Chiswick – Directions
West Middlesex University Hospital, Chelsea and Westminster Foundation Trust, Isleworth – Directions
