Proximal humeral fractures in adults
- Rebecca Bassett, MD
Rebecca Bassett, MD
- Adjunct Clinical Assistant Professor
- University of North Carolina School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Proximal humerus fractures occur most commonly in the elderly and their incidence is increasing. Fractures of the humerus can occur proximally, in the shaft (diaphysis), or distally. The majority of both proximal and midshaft humerus fractures are nondisplaced and can be treated conservatively (nonsurgically). Complex fracture patterns pose greater challenges for treatment.
Proximal fractures of the humerus will be reviewed here. Nonstress and stress fractures of the shaft of the humerus are discussed separately. (See "Midshaft humeral fractures in adults" and "Stress fractures of the humeral shaft".)
The humerus is the largest bone in the upper extremity. The proximal humerus articulates with the glenoid of the scapula to form the glenohumeral (shoulder) joint (figure 1 and figure 2 and figure 3). The muscles and tendons of the rotator cuff, the acromion, and ligamentous attachments, such as those between the coracoid process of the scapula and the acromion, both stabilize the glenohumeral articulation and provide for the shoulder’s wide range of motion. The distal humerus articulates with the radius and ulna at the elbow.
According to the Neer classification, the proximal humerus is divided into four sections: the anatomical neck, the surgical neck, the greater tuberosity, and the lesser tuberosity (figure 4) . (See 'Neer classification' below.)
●The anatomical neck consists of the widened articular surface of the humeral head.
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- PERTINENT ANATOMY
- EPIDEMIOLOGY AND RISK FACTORS
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- Fracture patterns
- - Neer classification
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- Duration of immobilization
- Subsequent visits
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS