Proximal Humerus Fractures

Modern Study Review (AI-Generated)

High-Yield Summary

Proximal humerus fractures are common injuries, especially in pediatric and elderly populations, with treatment strategies varying by age, fracture pattern, and displacement. In children, the high remodeling potential often allows for nonoperative management, but caution is warranted as skeletal maturity approaches. In adults, treatment decisions hinge on fracture complexity, vascular status, and functional demands, with operative intervention reserved for displaced, unstable, or vascular-compromised fractures.

Key Diagnostic Findings

Anatomy

• Proximal humerus includes the humeral head, anatomical neck, surgical neck, greater and lesser tuberosities.
• Important neurovascular structures: axillary nerve and posterior circumflex humeral artery run near the surgical neck; brachial plexus and axillary artery are at risk in severe displacement.

Clinical Presentation

• Pain, swelling, and limited shoulder motion after trauma.
• Deformity and crepitus may be present in displaced fractures.
• Assess neurovascular status meticulously, especially axillary nerve function and distal pulses.

Imaging

• Standard AP, lateral, and scapular Y views of the shoulder.
• CT scan for complex fractures or preoperative planning.
• Vascular imaging (e.g., CT angiography) if vascular injury suspected.

Classification Systems

Current Gold Standard Treatment

Non-operative

• Indicated for minimally displaced fractures, especially in children and elderly low-demand patients.
• Immobilization in a sling for 1-2 weeks followed by early passive and active range of motion.
• Close radiographic follow-up to monitor alignment and healing.

Operative

• Indications: displaced 3- or 4-part fractures, fracture-dislocations, open fractures, vascular injury, or failure of nonoperative management.
• Techniques include open reduction and internal fixation (ORIF) with locking plates, intramedullary nails, or arthroplasty in select cases.
• In pediatric patients nearing skeletal maturity with displacement >50% or angulation >20°, reduction and fixation with K-wires in the OR is preferred.
• Vascular injury requires urgent surgical exploration with proximal and distal vascular control, often via a deltopectoral approach with possible osteotomies for exposure.

Modern Complications & Outcomes

Complications

Outcomes

• Most minimally displaced fractures heal well with good pain relief and functional recovery.
• Surgical outcomes depend on fracture complexity and patient factors; modern locking plates and arthroplasty have improved results.
• Pediatric fractures generally remodel well, but careful monitoring near skeletal maturity is essential to avoid deformity.

Classic Clinical Notes

Proximal Humerus Fractures

• Usually treated closed.
• Expect lots of remodeling.
• As the child approaches skeletal maturity, you’ve gotta be a bit more careful:
• Over age 11: angulation less than 20 degrees, displacement less than 50% is acceptable.
• If you need to reduce, do it in the OR, and fix with K-wires.
• Open reduction should be reserved for vascular injury, open injury, or fracture dislocations (do not try reducing a glenohumeral dislocation with a proximal humerus fracture – you may nail the artery or nerve).
• If vascular injury – the goal is proximal and distal control:
• Deltopectoral approach, curved over clavicle proximally.
• Must take off pec major with something to repair back to later – this gives you much better exposure.
• The artery is behind pec minor proximally – drill, measure, then tap the coracoid and osteotomize it.
• Even more proximally, need to osteotomize the clavicle.

Last Updated on January 25, 2026 by orthonet