Proximal humeral fracture (summary)

This is a basic article for medical students and other non-radiologists

Proximal humeral fractures are a heterogeneous group of fractures that include everything from relatively simple transverse fractures of the surgical neck of humerus, to complex, displaced, multi-part fractures of the proximal humerus that extend into the shoulder joint. The shoulder is a hugely important joint and fractures of the proximal humerus can be devastating to quality of life.

Clinical features

Demographics

Proximal humeral fractures represent around 5% of all fractures ^?. They are most common in older populations and especially in those who are osteoporotic. As with other injuries, there is a bimodal distribution with a small peak amongst the young.

Presentation

Many older patients present following a relatively innocuous fall. Younger patients usually present following a high-trauma incident, e.g. a motor accident or fall from height. However, patients may present following a seizure, electrical shock or following direct trauma.

Diagnosis

Clinical examination (pain, and reduced range of motion) and a shoulder x-ray is all that is required. In complex multi-part fractures, further assessment with CT may be considered.

Treatment

Treatment depends on the severity of the injury. Simple surgical neck fractures may simply treated with a collar-and-cuff while more complex injuries will require internal fixation.

Pathophysiology

Indirect forces through the proximal humerus and shoulder the the cause of most fractures. These forces may be compressive, tension, torsion or bending.

Radiographic features

In most cases, all that is required for the diagnosis, treatment and followup of proximal humeral fractures is a shoulder x-ray.

X-ray features

The fracture line will be demonstrated on the radiograph. Description of the fracture should include:

• where it is
• what type it is (transverse, oblique, spiral, comminuted)
• if comminuted, how many parts there are
• degree of displacement (translocation, angulation and rotation)
• whether it extends to the joint surface

Differential diagnosis

Clinically, pain at the shoulder may be the result of a clavicular fracture or shoulder dislocation. However, once the plain film has been taken, the diagnosis shouldn't be challenging.