Nonoperative proximal humeral fracture rehabilitation protocol general principles. The most common cause of a proximal humerus fracture is falling over onto an outstretched hand. Download rehabilitation guidelines for proximal humerus fracture. It features the next generation in humeral plating, offering the surgeon. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. Rehabilitation is central to addressing the problems caused by the fracture. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Return to normal function and motion may require 3 to 4 months overall goals. Its upper surface is rounded and marked by three flat impressions. In our experience, proximal humerus allograft re construction was associated with a high complication rate and resulted in multiple revision procedures in.
The proximal humerus is the top portion of the humerus upper arm bone. Bony healing occurs usually within 6 to 8 weeks in adults 3. How much movement should be restricted following the fracture will depend on the severity of the break. Maintain range of motion rom without displacing the proximal humerus fracture. The proximal humerus is one of the bones in your shoulder joint. Proximal humerus fracture management linkedin slideshare. In 82 cases a nonsurgical treatment desault bandage in 11 cases, hanging cast in nine cases, closed reduction and shoulder spica cast in 62 cases was performed. Courtbrown found that 70% of all 3 and 4part fractures are seen in patients aged over 60 years and 50% in patients aged over 70 years. The major muscles that move the arm the rotator cuff. Patients should be seen in the fracture clinic or by an interested gp within 7 days for followup with x. The purpose of this study was to provide a guideline of normal mri developmental anatomy of the proximal humerus in a growing child. To evaluate the clinical effectiveness of surgical vs nonsurgical treatment for adults with displaced fractures of the proximal humerus involving the surgical neck. Humeral headsplit fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint. Shoulder fractures most often involve the clavicle collarbone, proximal humerus top of the upper arm bone, or the scapula shoulder blade.
Non displaced 2 part fracture good alignment does not involve an articular surface. Retrospective interpretation of 83 consecutive mri studies of shoulders in children 2 months to 17 years old was performed in consensus by two radiologists. Good outcomes depend on detailed fracture evaluation, careful patient selection with thorough consideration of individual patient characteristics, comorbidities and functional expectations and advanced surgical expertise across a wide range of. Post fracture proximal humerus rehabilitation guidelines. Jun 24, 2008 ninetyone children who had been treated for fractures of the proximal humerus 59 metaphyseal fractures. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. Risk factors o between ages 1116 average 14 age when proximal humeral physeal growth is at its peak o overhead sports baseball, tennis, volleyball, swimming. Healy and colleagues 1 reported on the outcome of 25 proximal. The need for surgery for the majority of patients with displaced proximal humeral fractures is unclear, but its use is increasing. The aim of this study was to investigate the epidemiology of proximal humerus fractures.
Proximal humerus fractures are rare in paediatric traumatology. Nonoperative management of proximal humerus fractures in the elderly used to be fairly common, but multiple studies have shown poor outcomes. Increase rom while protecting the fracture site you can be slightly more. Ruler for expert humeral nail parallel to the humerus so that the proximal locking slot symbolized on the ruler is located at the correct point against the proximal humerus. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder.
Proximal means it is the end of the bone that is closest to the body. Proximal humerus fractures are the third most common. Proximal humerus fractures account for a majority of fractures of the upper arm and 5% of all fractures. Classification this information is current as of january 22, 2009 reprints and. Proximal humeral fracture twin boro physical therapy. Extension and internal rotation not performed until 6 weeks 4. Proximal humerus fracture east sussex healthcare nhs trust. Proximal humeral fracture surgery in the covid19 pandemic. Proximal humerus fracture discharge care what you need. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Your pain does not get better or gets worse, even after you rest and take medicine.
Each of these plates is anatomically sidespecific, e. Most proximal humeral fractures do not require reduction as remodelling is extremely effective in the proximal humerus. The patient also had a history of metastatic prostate cancer. Bring the fractured proximal humeral shaft into the wound by removing the bolster and extending the arm in slight adduction. Position plate the proximal humeral locking plate is usually positioned 5 mm caudal to the proximal end of the greater tuberosity and 10mm dorsal to the posterior border of the intertubercular sulcus. We will take xrays a couple of weeks after your injury, then get the shoulder moving to avoid stiffness of the shoulder joint. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Oct 01, 2010 an analysis of the literature reveals few published series on the results of surgical treatment for nonunions of the proximal humerus.
Proximal humerus fracture is often seen in elderly population 1 and postmenopausal female. If a fracture or fracture repair is stable, then therapy should be started early. These plates are low profile, stainless steel and available in 2hole 75mm, 4hole 99mm, 6hole 123mm and 10hole 171mm lengths. Proximal humerus fractures by krr linkedin slideshare. This normally takes between 612 weeks to unite heal. We report the first case of a salter type 3 physeal fracture with posterior dislocation of the proximal humerus in a 16yearold boy. For complex and unstable fractures locking proximal humerus plate. Patients should be made aware that about 90% of recovery of the shoulder from proximal humerus fractures occurs in the first 34 months and the remaining 10% takes 6 months or longer much longer than other major joints in the body 7. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. This injury occurs right where the arm bone humerus connects with the shoulder blade scapula to form the shoulder joint.
Open reduction and internal fixation orif with lockedplate constructs has shown some promise, but it has been fraught with complications. Stable proximal humerus fracture rehab protocol introduction this protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Pdf arthroplasty for proximal humerus fractures grant. Salter type 3 fractures of the proximal humerus are rare injuries. The fracture is also observed in children mostly following fall and young adults following direct impact, which results in fracture. All books are in clear copy here, and all files are secure so dont worry about it. Nov 18, 2014 the management of proximal humerus fractures in adults is a challenging and demanding task. P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial. Functional bracing of fractures of the shaft of the humerus. Surgical technique locking proximal humerus plate depuy synthes 9 3.
They usually result from trauma in individuals this age. Fractures of the proximal humerus in children springerlink. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Shoulder dislocations can involve any of the three different joints that make up the shoulder. The most useful rehabilitation protocol is the threephase system. Humerus the long head of the biceps tendon and the lesser tuberosity are retracted anteromedially while the greater tuberosity is retracted posteriorly. In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation between 19% and 30%. Neer, ii and evaluation displaced proximal humeral fractures. In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone after hip fractures and wrist fractures. The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments, such as those between the coracoid process of the scapula and the acromion, stabilize the glenohumeral. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning.
The pdf of the article you requested follows this cover page. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Medical treatment for a proximal humeral fracture most often includes a period of immobilization using a sling, with the arm slightly abducted. Proximal humerus fracture you have a fracture break of your shoulder bone the proximal humerus. The fracture is actually at the top of the arm bone the humerus. Proximal humerus fractures in children and adolescents. The development and anatomy of the proximal humerus explain the various fracture types, displacements, and potential complications. Epidemiology of proximal humerus fractures springerlink. Pediatric proximal humerus fractures are a relatively common physeal and metaphyseal fracture of the proximal humerus seen in children with a peak age of 15 year of age. The upper part of the humerus forms part of the shoulder joint and the lower part of the bone helps form part of the elbow joint.
Broken shoulder proximal humerus fracture bone talks. Jul 15, 2012 proximal humerus fracture management 1. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Proximal humerus fractures are the third most common fragility fracture and they are associated with a substantial burden of disability and impaired quality of life. Surgical vs nonsurgical treatment of adults with displaced. Electrotherapy or hydrotherapy does not enhance recovery. Proximal humerus fracture book twin cities orthopedics. Read online rehabilitation guidelines for proximal humerus fracture. Most recently, reverse total shoulder arthroplasty rtsa has emerged as a possible surgical solution. Proximal humerus fracture shoulder 7 fracture care team. Especially common in elderly individuals due to osteoporosis, proximal humerus fractures are among the most common broken bones in the shoulder. Evaluation and management of pediatric proximal humerus fractures. Intramedullary nail for treating proximal humerus fractures.
Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. A proximal humerus fracture is sometimes referred to as a a broken shoulder or a broken arm. The humerus is the second most common site for long bone metastases following the femur. The profher proximal fracture of the humerus evaluation by randomization study 3 is a pragmatic randomized controlled trial conducted in 33 centers with 66 surgeons including senior residents. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Open subtypes 3 open subtypes 3 your digital gateway to expertise, education, and. Fractures of this region are common both with highenergy. The shoulder is a ball and socket joint and you have fractured the ball part. Fracture proximal humerus 5% of all fractures of all the fractures of the proximal humerus. Proximal humeral fxs majority occur in the elderly, minimally displaced and stable. This information aims to help you understand your condition and gain maximum benefit from your treatment.
The integra proximal humeral fracture plate system is designed for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus. Optilock upper extremity plating system proximal humeral plates. More severe shoulder fractures may require surgery to realign and stabilize the injury. Locking plate fixation for proximal humerus fractures. The shoulder joint is essentially a ball and socket joint. The fall doesnt need to be from any great height, falling from a standing height. Mark the skin over the proximal humerus at the top of the nail symbolized on the ruler. Skeletal development of the proximal humerus in the pediatric.
This information will guide you through the next 6 weeks of your rehabilitation. Shoulder trauma fractures and dislocations orthoinfo aaos. Longterm survival of proximal humerus allografts for reconstruction. Orif of fracture proximal humerus youve been listed for an operation orif open reduction and internal fixation of the proximal humerus the top end of your arm bone. A proximal humerus fracture is a break of the upper part of the bone of the arm. The usual treatment for this fracture is immobilisation of the shoulder in a sling, body swathe or shoulder immobiliser.
Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 3 april 2015 v1s. These results indicate that poor bone quality or even advanced osteoporosis will be found in the majority of patients. Challenges of proximal humerus fractures alexandra k. Intramedullary nailing for pathological fractures of the proximal. The most common location of proximal fractures is at the surgical neck of the humerus. The proximal humerus is important because it forms half of the shoulder joint. In addition, simple range of motion exercises such as pendulum swings and wall walkups should be encouraged and can be quickly demonstrated in the ed.
Interventions for proximal humerus fractures strengthening exercise. Most proximal humerus fractures are nondisplaced not out of position, but about 1520 percent of these fractures are displaced, and these may require more invasive treatment. Dislocated two, three, and fourfragment fractures of the proximal humerus, including fractures involving osteopenic bone pseudoarthroses in the proximal humerus. Treatment is nearly always nonoperative in younger patients due to the remodeling potential of the proximal humerus. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Approximately 19 628 health workers became infected during the execution of their duties.
Fractures involving the attachments of the rotator cuff. Common causes of a proximal humerus fracture include. The trigen humeral nail provides new possibilities for the treatment of proximal humeral fractures and humeral shaft fractures. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. The incidence of proximal humerus fractures is 4% to 5% of 1all fractures. Fractures of the proximal humerus are an increasingly common injury, accounting for 4% to 5% of all fractures 1,2 and 45% of all humeral fractures. Proximal humerus fracture is quite a common injury among elderly population who. Surgical technique proximal humeral fracture plate system. Metaphyseal fractures account for about 70% of cases and epiphyseal separation for the remaining 30%. This plate addresses complex fractures of the proximal humerus. Shoulder trauma fractures and dislocations orthoinfo. The humeral head is covered in articular cartilage and articulates moves against with the socket of the shoulder joint, the glenoid. Optimal treatment in elderly patients remains controversial, and an evidencebased approach is critical to improve patient outcomes and allocate limited health care resources 1 4. Among proximal fractures, 80% are onepart, 10% are twopart, and the remaining 10% are three and fourpart.
Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures. Bony healing occurs usually within 6 to 8 weeks in adults 2.
To the editor on 23 april 2020, the national health institute reported 177 143 confirmed cases and more than 23 188 confirmed covid19 deaths affecting italy. Nov 17, 2019 a proximal humerus fracture occurs when the ball, of the ballandsocket shoulder joint, is broken. Proximal humerus bone fractures overview verywell health. Proximal humerus fractures commonly occur in patients over age 65 especially women secondary to a fall on an outstretched had the presence of displacement, defined as fractures with greater than 1 cm of displacement and less than 45 degrees of angulation, often determines operative versus nonoperative management plan. The shoulder is a ball and socket joint and you have fractured just below the ball part. Sling immobilization with or without closed reduction also has a role in the management of displaced proximal humerus fractures. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. You should have received most of the information during your last consultation with me. Schwartz, md clinical professor chief orthopedic trauma university of california, san diego. The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral shoulder joint figure 1 and figure 2 and figure 3. A proximal humerus fracture is a common injury to the shoulder.