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
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.
Beginning therapy within 2 weeks has been shown to improved outcomes in proximal humerus fractures treated nonsurgically.
In some cases, treating proximal humerus fractures can result in complications, including:2
- 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
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
- 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.
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 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
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