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From the American Academy of Orthopaedic Surgeons

Four-part Proximal Humerus Fractures

by Joseph Zuckerman, MD; Arash Araghi, DO; Derek Plausinis, MD

Proximal humerus fractures include any fracture of the humerus proximal to the superior border of the pectoralis major insertion. Proximal humerus fractures account for 5% of all fractures. Because these fractures occur in metaphyseal bone and are more common in women and with aging, they are considered osteoporosis-related fractures. These fractures are most common in elderly persons, as a result of a fall onto the outstretched hand. The fall can take place from a standing height or less, and significant trauma is usually not involved. Uncommon in younger persons, these fractures usually are the result of significant trauma to the shoulder.

Management options for four-part proximal humeral fractures include nonoperative management, Open reduction and internal fixation, and proximal humeral replacement with tuberosity reattachment. The surgical technique of proximal humeral replacement is reviewed extensively. Video is available.

Keywords: shoulder fracture, shoulder joint fracture, broken arm, broken shoulder, incidence, mechanism of injury, classification, Neer classification, diagnosis, patient history, physical examination, imaging, radiography, differential diagnosis, management, nonoperative treatment, surgical treatment, surgical techniques, proximal humeral hemiarthroplasty, humeral head replacement, humeral head arthroplasty, shoulder arthroplasty, indications, contraindications, complications, outcomes, rehabilitation

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