Introduction:
Bones are one of the essential parts of the human body. Connective tissues, calcium, and some bone cells (osteocytes, osteoblasts, and osteoclasts) form the bones. There are around 206 bones in a human skeleton, including the skull, chest, spine, arms, legs, hands, and pelvis. Bones are divided into four types: long, short, flat, and irregular. The bone tissues are divided into four types: compact, spongy, periosteum, and bone marrow. The bones in the shoulder are made up of three types of bones: the clavicle (collarbone), scapula (shoulder bone), and humerus (upper arm bone). As the humerus is situated on the upper side, it is known as the proximal part of the bone.
What Is Proximal Humerus Fracture?
The humerus bone is one of the longest bones in the upper arm. It is present between the shoulder and elbow joints. The humerus supports many muscles, and many arteries and veins travel along with it. As the bones weaken, proximal humerus fractures are prevalent in older people. The term proximal humerus fracture is given as the fracture occurs in the humerus or upper arm bone situated at the proximal side.
How Is Proximal Humerus Fracture Classified?
The AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopedic Trauma Association) classification groups fractures by location, surgical neck status, and dislocation presence. The Neer classification focuses on the anatomical relationship of four segments: greater tuberosity, lesser tuberosity, articular surface, and shaft. A segment is considered separate if displaced by more than 0.39 inches or with 45° angulation.
What Causes Proximal Humerus Fracture?
Like any other type of fracture, proximal humerus fracture occurs due to trauma or accident. In young people, this fracture occurs when falling from a bike or a vehicle collision. In older people, the bones become weak or brittle and break easily. Falling from a standing height in such cases also leads to this fracture.
What Are the Signs and Symptoms of Proximal Humerus Fracture?
The symptoms include:
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Radiating pain.
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Swelling around shoulder and neck.
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Difficulty in moving the shoulder.
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In case of severe fracture, the deformity may occur.
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Bruising.
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Numbness around the shoulder.
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Occasional bleeding in case of open fracture.
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Grinding sensation on the shoulder.
How to Diagnose Proximal Humerus Fracture?
Firstly, a doctor will physically examine the patient and see the severity of the fracture. Next, the doctor will check the chest, arms, and forearm. Axillary nerve injury is widespread in such cases, so physical examination helps plan the diagnosis more clearly.
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CT (Computed Tomography) Scan - A CT scan helps characterize the shoulder and articulate movements. It uses a combination of X-rays through high-frequency energy. A healthcare expert will ask the patient to lie down on the machine's table. In a CT scan, the X-ray moves in a circular motion, capturing different angles or views of the affected site. Before getting the scan, certain precautions, such as removing any earrings or metal jewelry, are taken. If the test is without contrast, the patient can eat and drink before the examination. The technologist who handles the machine will sit in a different room and guide through a speaker connected in both rooms. The x-ray will absorb the body tissue, which will be transferred to the computer. The scan takes 15 to 30 minutes to complete.
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MRI (Magnetic Resonance Imaging) - In most cases of proximal humerus fracture, MRI is not advised, but if the injury is associated with soft tissue structure, then it helps in a more precise diagnosis. It also uses magnetic waves and a computer to record the images. During the examination, the machine generates a squeaky and thumping noise that may cause discomfort, so earplugs are given to block the noise. The examination sometimes takes more than half an hour to complete.
What Are the Treatment Options for Proximal Humerus Fracture?
Based on the severity of the fracture, there are non-surgical and surgical options available.
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Non-surgical - In most proximal humerus fractures, surgery is not needed. Instead, the doctor will give a sling to immobilize the shoulder. The bone takes three to four months to heal. Specific exercises are recommended during this period to regain motion and strength.
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Surgical - It is done when the fracture is quite severe and cannot be healed by nonsurgical treatment.
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Shoulder Replacement - This is a surgical procedure in which a prosthetic implant replaces all the parts of the shoulder joint. It is done when the joints are severely damaged. First, the cuff muscle that covers the shoulder joint is cut to get direct access to the shoulder muscle. Next, the joint surface is replaced by a metal ball attached to the stem and plastic socket. These parts are available in different sizes and are cemented or press-fitted into the bone.
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Intramedullary Rod Fixation - It is also known as an interlocking nail. In this surgical procedure, a metal rod is fixed into the medullary cavity of the bone. The rod helps stabilize the bone and corrects any deformity. To insert the rod, the doctor will use an orthopedic drill to create space in the marrow cavity of the bone. If the rod is inserted from the top of the femur, it is placed from the hip towards the knee. Once the bone is healed (around one year after surgery), the rod may be removed.
The doctor will advise avoiding specific movements like lifting heavy things and removing the sling daily to do elbow and wrist exercises. Then, as the bone heals, the shoulder regains its ability to lift heavy things and move the shoulder without any stiffness. Healing in surgical cases can take a long time and cause soreness. Physical therapy will be done after surgery for a few months.
Conclusion:
The humerus bone is the upper arm bone, and around 10 percent of fractures recorded are proximal humerus fractures. It is very common in old age people due to age and conditions like osteoporosis, which make bones weak and brittle. Female cases are recorded more than males. Almost all humerus fractures heal without any surgical intervention. However, a surgical procedure like shoulder replacement is done in some cases, like open fractures in which bone breaks through the skin. Taking physical therapy regularly and avoiding movements as the doctor told me will help in faster healing of the bone.
