Proximal Humerus Fracture

Question 1

What is the MOI?

Answer 1

1. FOOSH
2. Direct blow to arm
3. Common site for pathology fracture metastatic breast CA

Question 2

If there are more pieces associated with the fracture what does that mean?

Answer 2

1. Greater the necessity for surgery

Question 3

What are the symptoms and PE signs?

Answer 3

1. Pain
   *worse with any movement of proximal arm
2. Swelling
3. Bruising
4. Loss of feeling
5. Paleness of affected arm (axillary artery injury)
   *arm will typically be adducted

Question 4

What are some diagnostic tests?

Answer 4

1. Shoulder radiographs
2. MRI-eval for associated RCT, biceps injury or other injury
3. Check for brachial plexus or axillary nerve injuries

Question 5

What is the treatment? (Non-surgical)

Answer 5

1. Sling and therapy (if minimal displacement, 4-6 weeks)
   *begin motion prior to fracture healing to prevent stiffness

Question 6

What is the surgical indication?

Answer 6

1. 2 part fracture with >1cm of displacement of greater tuberosity as well as other displaced classifications
   *if there is a 4 part fracture that will increase the risk of avascular necrosis due to disruption of blood flow

Question 7

When should this be referred?

Answer 7

1. Refer all to ortho