Proximal Humeral Fracture
If there are neurological or vascular deficits or involvement of the shoulder/elbow joints → urgent orthopaedic referral is required.
📖 About
- Common after FOOSH (fall onto outstretched hand) in older patients; often direct trauma in younger.
- Upper third humeral fractures: proximal fragment pulled medially by pectoralis major.
- Middle shaft fractures: distal fragment abducted by the deltoid.
🧾 Aetiology
- Trauma (most common)
- Pathological bone: osteoporosis, Paget’s disease, metastases
- Mechanism: FOOSH or direct blow
- Sites: anatomical/surgical neck, greater or lesser tuberosity involvement
🩺 Clinical Features
- Severe localised pain, tenderness, swelling, bruising.
- Limb often held and supported by opposite hand.
- Radial nerve injury: wrist drop, loss of sensation over dorsum of hand (radial nerve runs in spiral groove).
- Axillary nerve injury: loss of sensation over “regimental badge” area + weak shoulder abduction.
- Always assess brachial plexus function and distal pulses (brachial artery injury risk).
🔍 Investigations
- Bloods: FBC, ESR, U&E, calcium (rule out pathological cause).
- X-rays: AP + lateral (Y view or trans-scapular) + axillary views of shoulder.
- CT: for complex/unclear fractures or pre-op planning.
⚠️ Complications
- Radial nerve palsy (~10–18% of shaft fractures).
- Compound/open fractures.
- Malunion or non-union (esp. in pathological bone).
🛠️ Management
- Refer to orthopaedics urgently if:
- Gross angulation/comminution
- Open/compound fracture
- Associated radial nerve palsy
- Vascular injury
- Otherwise:
- Immobilise with U-slab plaster or hanging cast; pad well with cotton wool.
- Provide analgesia (paracetamol, opioids if severe).
- Arrange fracture clinic follow-up within 1 week.
📚 References
- Rockwood & Green’s Fractures in Adults
- British Orthopaedic Association (BOA) Guidelines
