- Fracture lines involve parts
- three parts are displaced (i.e. >1cm or>45 degrees) with respect to the 4th
- These fractures are uncommon ( < 1% of proximal humeral fractures).
This pattern has poor non-operative results and as the articular surface is no longer attached to any parts of the humerus which are attached to soft tissues, it has a high incidence of osteonecrosis. These fractures require operative management.
» Treatment of Proximal Humerus Fractures
About 80% of proximal humerus fractures are non-displaced (not out of position) and these can almost always be treated in a sling. Typical treatment is to rest the shoulder in the sling for 2-3 weeks and then begin some gentle range-of-motion exercises. As healing progresses, more aggressive shoulder strengthening exercises can resume, and full healing typically takes about 3 months.
In more severe injuries where the bone is displaced (out of position), it may be necessary to realign or replace the damaged bone. Determining the best treatment depends on many factors including :
- Age of the patient
- Hand dominance
- Activity level of the patient
- Degree of displacement of the fracture
The options for surgery include realigning the bone fragments and holding them in position with metal implants, or a shoulder replacement procedure is performed. If the fragments of bone can be fixed by either pins, screws, wires, large sutures or a plate will be used to hold the bones in place.
If there are concerns about repairing the bone, it may be decided to perform some type of shoulder replacement. If a replacement procedure is recommended, options include a standard shoulder replacement, a hemiarthroplasty, or a reverse shoulder replacement