Proximal humerus fracture treatment

Symptoms

The most common symptoms are pain and swelling in the shoulder. There is frequently black and blue discoloration of the skin indicating a fracture has occurred, and range of motion is very limited because of pain. The lower arm and hand can swell considerably, which is why it is strongly recommended to remove all jewellery, rings especially, from the affected arm.

Why it happens

Fractures about the shoulder result from trauma. In the elderly, a simple fall onto the shoulder can cause one, and the humeral head may dislocate from the socket during the injury. Rarely, seizures cause fracture-dislocations of the shoulder. In younger patients, high-energy trauma such as a motor vehicle accident is usually responsible, and there may be other associated injuries — a collapsed lung, internal bleeding, other fractures — so evaluation in an emergency room is necessary. The rotator cuff is frequently injured as well, and can be a persistent problem for the patient.

How it is diagnosed

Diagnosis begins with a detailed history and a thorough physical examination by Dr. Seneviratne. X-rays are the most important initial study, with several views taken. A CAT scan may be added, particularly for a complex fracture.

Treatment

A significant proportion of proximal humerus fractures can be treated non-operatively with a sling, pain control and swelling control. Dr. Seneviratne monitors these carefully with weekly or fortnightly X-rays to make sure the fracture is healing without displacing.

Surgery is required for displaced fractures and where the humeral head is dislocated as well as fractured. There are two main categories.

ORIF (open reduction internal fixation) involves putting the fracture together like a puzzle and holding it with metal plates and screws, or with an intramedullary nail. The approach and incision size vary with your anatomy and your particular fracture.

Hemiarthroplasty is used where the fracture is complex and extensive: the upper portion of the humerus is replaced with a shoulder prosthesis, usually fixed to the bone with cement. The incision is at the front of the shoulder and varies from roughly 6 to 10 inches depending on anatomy.

Reverse shoulder arthroplasty places the ball on the opposite side to normal anatomy, which allows better function of the arm. It is being used increasingly for shoulder fractures because of favourable results. Dr. Seneviratne evaluates each patient carefully before recommending it.

In hospital

If you were admitted on the day of surgery for ORIF, you may be discharged the same day depending on the extent of the surgery, though most patients are admitted. You will be given pain medication and antibiotics to prevent infection. Foot pumps are placed on your feet to pump blood back to the heart and prevent clots, and you will be given an incentive spirometer — a breathing device to help expand your lungs. Physical therapists begin rehabilitation immediately, and you will typically be in a sling. Most patients are discharged within 1 to 3 days. Whether you go home or to an inpatient rehabilitation facility is decided by the team: your surgeon, physical therapist, nurse and case manager.

After you go home

If you are discharged home you will need someone to help with daily activities. You will see your surgeon 7 to 10 days after surgery for suture removal and further care. If you are discharged to an inpatient rehabilitation facility, your skin staples are removed there, and you will typically spend 1 to 2 weeks before discharge.

Physical therapy begins during the first six weeks, and you may need it for up to six months.