This accounted for 15% of all proximal humeral fractures. Nonoperative proximal humeral fracture rehabilitation protocol general principles. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Radiographic templates of the stem and humeral head are used to preoperatively estimate the implant sizes. Fractures of the humerus can occur proximally, in the shaft diaphysis, or distally. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. A proximal humerus fracture is a crack or break in the top of your upper arm bone. Proximal humerus fracture east sussex healthcare nhs trust. Proximal humeral fractures are witnessed mainly in the elderly population, with the highest prevalence being 405 per 100,000 in those patients aged over 70 years. Maintain range of motion rom without displacing the proximal humerus fracture.
Proximal humeral fractures are relatively uncommon fractures, accounting for 5% of all fractures at an incidence of 66100,000 person. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. Proximal humerus fracture an overview sciencedirect topics. When glenohumeral dislocation accompanies fracture of the proximal humerus, the articular head fragment tends to be displaced into the axilla. A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns. If the neer classi cation is used, 49% of all proximal humeral fractures are in the minimallydisplaced category. A further three fracture con gurations figure 2 had an incidence of at least 10%, these being the a2. Proximal humeral fractures are osteoporosisrelated fractures and are much more common in women than in men.
The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm. Humerus fracture upper arm fracture johns hopkins medicine. Non displaced 2 part fracture good alignment does not involve an articular surface. Proximal humerus fractures represent circa 5% of all fractures, with notable increase of incidence in elderly women. Nondisplaced means less than 1cm of displacement and less than 45. A proximal humerus fracture is a break of the upper part of the bone of the arm. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. Regarding young patients, they are mostly the result of highenergy traumas, whereas in the older population these fractures occur commonly due to osteoporotic bone constitutions. Nonoperative treatment with shortterm immobilization is a wellapproved treatment option and has shown good clinical results in stable and minimally displaced fractures as well as in certain displaced fractures. Proximal humeral fractures occur most commonly in older adults, and their incidence is increasing.
Proximal humerus fracture with glenohumeral dislocation. Proximal humerus fractures fractures of the ball of the humerus are relatively common particularly in those affected by osteoporosis. External fixation for displaced 2part proximal humeral. Proximal humerus fracture book twin cities orthopedics. Proximal humeral fractures are typically treated successfully using. Rehabilitation programs for operative and nonoperative. Proximal humeral fracture postsurgical rehabilitation protocol. Proximal humerus fracture shoulder 7 fracture care team. For this study, 143 consecutive proximal humeral fractures due to lowvelocity trauma were included. Bony healing occurs usually within 6 to 8 weeks in adults 2. 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. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Coaptation splint temporary to provide initial comfort and.
Proximal humeral fracture postsurgical rehabilitation. This is an enhanced pdf from the journal of bone and joint surgery. The humeral head and tuberosity fragments may be manipu. We also commonly see this fracture pattern, and it typically involves a fracture of the greater tuberosity, lesser tuberosity, and the surgical neck. Nonoperative proximal humeral fracture rehabilitation protocol. This is when the proximal humerus is fractured, and the joint surface of the ball humeral head. The integra proximal humeral fracture plate system is composed of left and right humeral reconstruction plate implants in two options, gt plate and lp plate. 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 approximate location of the original humeral shaft medial calcar is. Philos plate fixation for proximal humeral fractures article pdf available in journal of orthopaedic surgery hong kong 171. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly. Update in the epidemiology of proximal humeral fractures. These fractures tend to occur in older patients who are osteoporotic.
Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Fractures of the proximal humerus are common, accounting for 5% of all fractures. The expert humeral nail can be inserted into the humeral shaft in both antegrade and retrograde directions. Bony healing occurs usually within 6 to 8 weeks in adults. Return to normal function and motion may require 4 months 6 months. Rehabilitation programs for nonoperative humeral fractures dr. Proximal humeral fracture repair and rehabilitation. Mark the skin over the proximal humerus at the top of the nail symbolized on the ruler. This is when the proximal humerus is broken into four pieces. The gt plate is designed to cover the greater tuberosity and is available in fourhole 91mm and sevenhole 115mm, and tenhole 8mm lengths or sizes. Proximal humerus fracture is quite a common injury among elderly population who.
The php is an anatomically designed, low profile, titanium locking plate and screw system. The most common cause of a proximal humerus fracture is falling over onto an outstretched hand. Use of kwires as joysticks to manipulate the proximal head fragment is required. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Rehabilitation guidelines for proximal humerus fracture non operative 3 p a g e appointments continue physical therapy 12 xweek rehabilitation goals increase rtc strength restore scapulahumeral rhythm precautions none suggested therapeutic exercises posterior capsule stretching if indicated. The neer classification for proximal humerus fractures is based on 4 fracture parts. Pdf most proximal humeral fractures are stable injuries of the ageing population. Fixation of proximal humeral fractures with an intramedullary nail. The proximal humerus is important because it forms half of the shoulder joint. Severely displaced proximal humeral epiphyseal fractures. The most useful rehabilitation protocol is the threephase system. Orthogonal xray views are then used to identify and. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. The majority of both proximal and midshaft humeral fractures are nondisplaced and can be treated conservatively ie, nonsurgically.
The pdf of the article you requested follows this cover page. Although the majority of minimally displaced fractures are successfully managed nonoperatively the optimal management of displaced or complex fracture remains controversial. Proximal humeral plating system the aos php is indicated for fractures, fracture dislocations, osteotomies, and nonunions of the proximal humerus. This information leaflet follows up your recent telephone conversation with the fracture care team explaining the ongoing management of your injury. Pdf arthroplasty for proximal humerus fractures grant. The fracture is also observed in children mostly following fall and young adults following direct impact, which results in fracture. Read online rehabilitation guidelines for proximal humerus fracture. Open reduction and internal fixation has been the treatment of choice for displaced 2 and 3part proximal humeral fractures, whereas hemiarthroplasty or total shoulder arthroplasty is the. Fracture of the proximal humerus in children and adolescents. Anatomy the proximal humerus is the top portion of the humerus upper arm bone. Common causes of a proximal humerus fracture include. The humeral head is covered in articular cartilage and articulates moves against with the socket of the shoulder joint, the glenoid. The fall doesnt need to be from any great height, falling from a standing height. Proximal humeral fractures follow the standard bimodal distribution in trauma, resulting from highenergy mechanisms in young patients often motor vehicle collision or fall from height, and lowenergy mechanisms in elderly patients often groundlevel falls.
The acromion acts as a fulcrum of a lever and the depending on the quality of the tissues of the shoulder complex the humerus may fracture, dislocate, or both dislocate and fracture. Surgery is usually needed to reduce the dislocated fragment, which is now devoid of capsular and tendinous attachments. This injury is most commonly a result of a fall onto the affected side or shoulder. It can be used universally for either the left or right humerus. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. 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. No pt for 3 weeks, unless otherwise specified by md. Proximal humerus fracture is often seen in elderly population 1 and postmenopausal female. According to the neer classification, 93 were nondisplaced and 50 were displaced fractures. The aim of this study was to investigate the epidemiology of proximal humerus fractures. Increase rom while protecting the fracture site you can be slightly more. Surgical technique proximal humeral fracture plate system.
A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. Neer, ii and evaluation displaced proximal humeral fractures. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Bony healing occurs usually within 6 to 8 weeks in adults 3. The proximal humerus is one of the bones in your shoulder joint. 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. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. Difficulties arise due to the risk of devascularisation of the humeral head, associated injury to the rotator. Proximal humeral fractures are the third most common type of fractures in those over 65 years of age.
Proximal humerus fractures the hospital for sick children. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Proximal humeral fracture surgery in the covid19 pandemic. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. Current concepts in locking plate fixation of proximal.
The treatment of proximal humeral fracture in adults. Mathes proximal upper humerus arm bone fractures breaks are common injuries. 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. Figure 3 computed tomography in proximal humeral fracture. Post fracture proximal humerus rehabilitation guidelines. Indications for treating these fractures conservatively, with surgical.
The integra proximal humeral fracture plate system is designed for fractures and fracture dislocations, osteotomies and nonunions of the proximal humerus. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. There may not be a crack heard or felt but there is immediate pain and rapid swelling. All books are in clear copy here, and all files are secure so dont worry about it. The shoulder is a ball and socket joint and you have fractured just below the ball part. Fractures of this region are common both with highenergy. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. While nondisplaced fractures can be managed conservatively, displaced. Proximal humeral fractures are commonly encountered in the emergency department neer classification is the most widely used approach to fracture description while radiographs and cts are frequently used in the setting of proximal humeral fractures, mri is rarely used avascular necrosis of the humeral. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 april 2015 v1s. Frequently the cause of injury is a fall on the outstretched hand from standing height. Standard techniquesmall fragment lcp instruments and proximal humerus instrument set 4 reduce fracture instrument 292.
Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Sep 02, 20 the incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. The humeral head is covered in articular cartilage and articulates. The appropriate radiographs of the proximal humeral fracture are analyzed in conjunction with radiographs of the opposite side.
Around the world, this type of fracture remains a major challenge for treating surgeons. The commonest single fracture con guration seen during the study period was the ao b1. 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.
Damned if you operate, and damned if you dont commentary on an article by c. This normally takes between 612 weeks to unite heal. Fractures of the shaft and distal humerus on the other hand, are more common than proximal humeral fracture in the young population. Extension and internal rotation not performed until 6 weeks 4. Proximal humeral fractures are commonly encountered in the emergency department neer classification is the most widely used approach to fracture description while radiographs and cts are frequently used in the setting of proximal humeral fractures, mri is rarely used avascular necrosis of the humeral head is associated with. The neer classification of proximal humeral fractures is probably the most frequently used system along with the ao classification of proximal humeral fractures. I think most would define successful fracture treatment as a functional union with minimal deformity.
General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. Download rehabilitation guidelines for proximal humerus fracture. The shoulder joint is essentially a ball and socket joint. There are only a few previous populationbased studies that include both inpatient and outpatient treatment data. Humerus fractures functional union acceptable deformity. Dislocated two, three, and fourfragment fractures of the proximal humerus, including fractures involving osteopenic bone pseudoarthroses in the proximal humerus. Proximal means it is the end of the bone that is closest to the body. Neer classification of proximal humeral fractures radiology. Pdf philos plate fixation for proximal humeral fractures. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone.
Proximal humeral fractures account for 10% of all fractures and the incidence is rising. Proximal humeral fractures are the most common of all humeral fractures approximately 45% 14 and account for 4% to 5% of all fractures. In a skeletally immature athlete, the fracture frequently presents as a fracture at the proximal humeral growth plate or physis little leaguers shoulder. If a fracture or fracture repair is stable, then therapy should be started early. Management of proximal humeral fractures based on current. Epidemiology of proximal humerus fractures springerlink. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. A further 28% are twopart surgical neck fractures and 9% are threepart greater tuberosity and surgical neck fractures.
There are three main contributions to the vascular supply of the humeral head. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Rehabilitation after proximal humeral fractures erin singleton, dpt, robert turner, pt, ocs, and lawrence gulotta, md abstract. This protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired.
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