![]() SURGICAL TREATMENT – WHEN IS IT RECOMMENDED? After the first month and, as appropriate, shoulder strengthening exercises are added. suspension folder), followed by a physiotherapy program that includes gentle stretching of the shoulder to restore movement. ![]() In this case, the injured limb is placed on a shoulder immobilization system for 2 to 4 weeks (e.g. Therefore, in the case of slightly displaced fractures, conservative treatment can result into very good operating results. In addition, the poor quality of bone may lead to failure of osteosynthesis. Some patients may not be able to get surgery due to serious health problems or a lack of co-operation and compliance. When the fracture is minimally displaced or when surgery may cause more problems (poor bone quality and concomitant pathological problems), conservative treatment is chosen. TREATMENT MAINTENANCE TREATMENT – WHEN IS IT RECOMMENDED? In this case, which may take years, deformity, sedimentation and severe arthritis may occur with consequent pain and reduced functionality. The risk of interruption of the blood flow increases as fractures become more complex and displaced and can lead to aseptic necrosis of the humeral head or osteonecrosis. Elderly patients, due to osteoporosis, lose some of their bone mass and their bones become thinner, slimmer and therefore weaker.Īnother important factor is the blood flow of the head of the humerus and its maintenance after injury. This provides multiple combinations of fractures that are treated differently, as appropriate.ĪDDITIONAL INFORMATION CONCERNING THE FRACTURE OF THE PROXIMAL END OF THE HUMERUSīone quality is an important factor in choosing the right treatment for a fracture. In order to characterize a piece displaced in relation to others, it must create an angle greater than 45° and a displacement greater than 1 cm. The major and minor tubercles are sites of insertion of the rotator cuff tendons. According to the Neer classification, which is still in force, there are – potentially – four parts at the proximal end of the humerus the head, the major and minor humeral tubercles and the diaphysis. The concept of fractured segments, described and illustrated below, is an important factor in deciding the proper treatment of a fracture, whether it is conservative or surgical. A comminuted fracture refers to multiple fracture segments that can result from injury. However, it is not a screening test for fractures of the proximal end of the humerus.ĬLASSIFICATION – Are there different types of fractures?įractures of the proximal or upper end of the humerus generally depend on the quality of the bone, the number of fractured “pieces” and the size of the comminution. Magnetic resonance imaging (MRI) is able to visualize in detail – beyond the fracture – the soft tissue structures. In the emergency department, specific “trauma” shots (anteroposterior, transthoracic and axillary) are used to visualize the fracture in detail.Ĭomputed tomography (CT) is not necessary for diagnosis, but is able to accurately and in detail describe a more complex fracture that may need further treatment (preoperative planning for surgery). ![]() Radiological examination is usually sufficient to describe and confirm the diagnosis of a humeral fracture. A bone requires a greater amount of energy to be fractured, such as in a car accident or after falling from height, etc. Young patients generally have stronger bones that cannot be fractured with a simple fall. In elderly patients, where bones are osteoporotic, less force is required (low force injuries). The fractures of the proximal end of the humerus are in most cases the result of a fall or severe injury, such as car accidents. Reason – How do the fractures of the proximal humerus end occur? The fracture of the proximal end of the humerus concerns that part of the bone next to the glenoid cavity. In the case of the humerus, the proximal part corresponds to the “head” and therefore the fractures are also classified as fractures of the humeral head.Ī fracture is defined as the discontinuation of a bone’s structure, that is, a “break”, and is usually the result of a fall or more serious injury. In contrast, the outer part of the bone is described as “distal”. When the word “proximal” is used to describe a part of the human body, it means that it is closer to the center of the body. It is a spherical type of joint with high mobility and reduced stability.ĭESCRIPTION – WHAT IS THE PROXIMAL HUMERUS FRACTURE? The shoulder joint (glenohumeral joint) is a diarthrosis consisting of the head of the humerus and the glenoid cavity, part of the scapula. ![]()
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