Upper Arm Bone Fractures (Proximal Humerus Fractures): Treatment Options

Upper Arm Bone Fractures (Proximal Humerus Fractures): Treatment Options

If you think you have sustained an upper arm bone fracture, also known as a proximal humerus fracture, it is important to seek care. Although many proximal humerus fractures will go on to heal without requiring surgery, a trained orthopedic specialist will need to evaluate and determine if nonsurgical versus surgical treatment will be required.

If more complex fractures are left untreated, the bones may heal in the wrong position or may not heal back together at all. This can lead to persistent pain and limited range of motion in the affected arm. After injury, when the patient seeks care in the emergency room, the first steps in treating an upper arm bone fracture will focus on making the patient comfortable. The affected arm will be immobilized and pain medication will be provided as needed so the patient can undergo proper imaging tests and lessen discomfort between the initial injury and potential surgical treatment.

There are many factors the orthopedic specialist will take into consideration when recommending treatment options for an upper arm bone fracture, including but not limited to, age of the patient, medical history, activity level, and the evaluation of the fracture pattern itself. Nonsurgical treatment for upper arm bone fractures is typically recommended for fracture patterns where the bony pieces remain close together, referred to as nondisplaced or minimally displaced. The majority of upper arm bone fractures fall into this category. These type of fractures have a healing success rate of 80-85%. Additionally, those who are not medically fit to undergo surgery will also be recommended for nonsurgical treatment.

Nonsurgical treatment will consist of immobilizing the affected arm in a sling, gradually introducing gentle range of motion exercises, and starting formal physical therapy. The orthopedic specialist will monitor healing of the fracture through x-rays every few weeks.

If surgery is recommended, there are several procedures available. The surgeon will take many factors into consideration like bone quality, patient age, activity level, and type of fracture when discussing these options with the patient. Some of these options include a plate with screws, a bone nail, a partial shoulder replacement, and a reverse shoulder replacement. We will briefly review using a plate with screws and a reverse total shoulder replacement as surgical treatment options. Both of these procedures will require an open incision on the front of the shoulder.

When using a plate with screws, the surgeon will fit the broken pieces of bone back together like a puzzle, also called reducing the fracture. Once reduced, the plate and screws are applied to hold it together while the fracture heals. Throughout the procedure, the surgeon will take x-rays to ensure the pieces stay together and the hardware is in the appropriate alignment.

A reverse total shoulder replacement might be chosen if the fracture fragments cannot be put back together or for older patients with poor bone quality. Why is it called a reverse shoulder replacement? Our shoulder is a ball and socket joint and in a total shoulder replacement used in the treatment of shoulder arthritis, the ball is replaced with a ball and the socket with a socket. In this procedure, it is reversed. Where the ball once was is replaced with a socket and the socket is replaced with a ball. This allows for patients to use different muscles in the shoulder to move their arm if others were damaged.

Rehabilitation following surgery will vary depending on the procedure performed. Generally, patients will be in a sling after surgery to immobilize the shoulder joint. X-rays will be performed to confirm the position of the hardware chosen and if the fracture was fixed, to monitor the healing. After a few weeks, physical therapy will begin, focusing first on regaining motion in the shoulder joint, followed by strengthening activities tailored to the patient's goals for return to activity.