Proximal humeral fractures

Abstract

The proximal portion of the humerus- the upper part of the upper arm bone-represents only a small portion of this bone, but can provide several different fracture sites: the humeral head, anatomical and surgical necks, the greater tuberosity, and adjacent segments of the shaft. Each type of fracture characteristically follows a particular type of injury. In older patients, osteoporosis is an underlying factor. Fractures of the proximal humerus rarely lend themselves to conservative external fixation. Operative treatment involves a variety of possible internal fixation techinques, including nails, screws, pins, plates and sometimes bone grafts. Prognosis usually depends on complications of the fracture: impaired union and musculoskeletal function, neurovascular injuries, and abnormal bone growth, particularly with complicated extensive fractures. Management requires a thorough understanding of humerus function and shoulder anatomy. Postoperative care should include diligent follow-up as well as a comprehensive rehabilitation program.