Fractures of the humerus (upper arm) bone near the shoulder joint are called proximal humerus fractures. This type of fracture often involves the head of the humerus (ball) fracturing away from the shaft of the humerus. As part of this fracture pattern, the area of bone to which the rotator cuff attaches may be fragmented.
If the fractured bone remains in good alignment, a sling may be all that is needed to allow the fractured bone to mend. However, if the bone fragments displace or move out of position, then a surgical procedure may be necessary to restore the normal anatomic relationship to the shoulder joint.
Patients usually sustain a proximal humerus fracture from a fall on an outstretched hand or elbow. This injury usually causes severe pain initially with bruising and inability to lift the shoulder. Patients often are initially treated in an emergency room or urgent aid center with a sling to immobilize the shoulder. Evaluation by an orthopaedic surgeon is necessary to determine a treatment course.
The x-ray above to the left shows a displaced proximal humerus fracture where the shaft has been impacted up through the humeral head (blue arrow) and caused fragmentation of the bone where the rotator cuff attaches. Without a surgical realignment and fixation of the bone fragments, this injury will likely result in a persistently painful shoulder that cannot be used for daily activities. In these cases a procedure that uses a plate and screws, bone grafting and high strength sutures through the rotator cuff is used to restore the bone to its anatomic alignment. In the picture above and to the right the blue arch demonstrates restoration of the normal contour of the humerus and scapula.
Depending on patient factors and the severity of the fracture, a shoulder replacement may be the optimal treatment to restore function to the shoulder. In these situations, a hemiarthroplasty (replacement of the ball of the humerus) or a reverse shoulder replacement may be suitable. Pre-operative planning with an orthopaedic surgeon is necessary to determine if a shoulder replacement is needed.
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