About 80% of proximal humeral fractures are what medical professionals call non-displaced—meaning the broken bones remain in their correct anatomical position. Non-displaced and minimally displaced fractures can usually be treated successfully without surgery. Conversely, surgery may be necessary when bones are displaced from their normal positions. Nonetheless, treatment of displaced fractures in the elderly remains controversial due to poor bone healing. 1 Südkamp N1, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009 Jun;91(6):1320-8.

See The 3 Types of Shoulder Fractures

In This Article:

Nonsurgical Treatment for a Proximal Humerus Fracture

Examples of nonsurgical treatment are as follows:

  • Immobilization. Wearing a sling provides arm support and immobilization. A swathe is another immobilization option that provides extra support and further reduces movement by wrapping horizontally around the chest and arm. A doctor will typically recommend keeping the arm immobilized for about 2 to 3 weeks, but the amount of time can vary on the fracture type, age of the patient, and other medical conditions.
  • Pain control. Physicians will often prescribe nonsteroidal anti-inflammatory drugs, including ibuprofen, and/or other pain medications during the healing process.
  • Range-of-motion exercises. Gentle range-of-motion exercises may begin 7 to 10 days after injury.
  • Physical therapy. A doctor may prescribe appointments with a physical therapist. Physical therapy can start 2 to 3 weeks after the injury occurs.

See Treating Acute Sports and Exercise Injuries in the First 24 to 72 Hours

Beginning therapy within 2 weeks has been shown to improved outcomes in proximal humerus fractures treated nonsurgically.

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In some cases, treating proximal humerus fractures can result in complications, including: 2 Jo MJ, Gardner MJ. Proximal humerus fractures. Curr Rev Musculoskelet Med. 2012;5(3):192-8.

  • Shoulder stiffness.
  • Posttraumatic arthritis of the joint.
  • Poor function of the shoulder.

Less common but more serious complications include a fracture failing to heal and bone death caused by an insufficient blood supply (avascular necrosis). If the fractured upper arm bone is immobilized for too long, the patient may be unable to move the shoulder (a condition called frozen shoulder, or adhesive capsulitis). 3 Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55.

See Frozen Shoulder Symptoms

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Surgical Treatment for a Proximal Humerus Fracture

In some cases, the broken proximal humerus must be surgically repaired or replaced. Surgeons may use nails, plates, and screws to secure pieces of bone together. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced.

Surgery may be necessary or recommended for: 4 Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int. 2013;110(35-36):591-7.

  • Dislocated fractures, in which the humeral head has dislocated from the shoulder socket.
  • Open fractures, in which the bone penetrates the skin.
  • Injuries to surrounding blood vessels and nerves.
  • Humeral head-split fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint.
  • Displaced fractures in younger patients.
  • Fractures involving the attachments of the rotator cuff.

See Rotator Cuff Injuries

Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. In particular, surgical fixation of the proximal humerus in elderly patients carries a higher risk of implant failure and reoperation (between 19% and 30%). 5 Südkamp N1, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009 Jun;91(6):1320-8. And cited in Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55. People who undergo these surgeries also face similar risks as people who undergo nonsurgical treatment, such as shoulder arthritis.

Treatment of displaced proximal humerus fractures in the elderly population has improved with recent advancements in shoulder replacement. Reverse shoulder replacement, when the ball and socket are both replaced but in “reverse” alignment from normal anatomy, has become increasingly utilized for this difficult problem. Research has shown that reverse shoulder replacement can lead to improved function, decreased pain, and increased satisfaction following displaced fractures. 3 Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55.

Full recovery from a proximal humeral fracture can take about one year, but progress can depend on a number of factors, including:

  • Age: children tend to heal all fractures much faster than adults.
  • Compliance: people who follow their early rehabilitation program tend to have better shoulder healing, function, and movement.

Progress can also depend on the type of treatment. Elderly patients who undergo reverse shoulder replacement may regain better function than those who have partial replacement. 3 Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55.

  • 1 Südkamp N1, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009 Jun;91(6):1320-8.
  • 2 Jo MJ, Gardner MJ. Proximal humerus fractures. Curr Rev Musculoskelet Med. 2012;5(3):192-8.
  • 3 Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55.
  • 4 Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Müller LP. The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int. 2013;110(35-36):591-7.
  • 5 Südkamp N1, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am. 2009 Jun;91(6):1320-8. And cited in Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul;20(5):747-55.

Dr Ian Bryam is an orthopedic surgeon specializing in shoulder, elbow, and sports medicine. He practices at the Bone and Joint Institute of Tennessee. Dr. Byram has served as a team physician at the high school and college level, and he has helped provide orthopedic care for the New York Yankees. He is the co-author of numerous articles published in professional medical journals.

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