Classification, Investigation and Treatment of Shoulder Joint Fracture:

Proximal Humeral Fractures is common in elderly patients and it accounts for 4 to 5 percent of all fractures. It is more common in elderly females due to osteoporosis.

Mechanism

• Fall on the outstretched hands is the classical history.
• Blow on the lateral side of the arm is the other mode of injury.

Classification

Four segments are described with respect to proximal humerus. These are:

• Anatomical neck
• Greater Tuberosity
• Lesser Tuberosity
• Shaft or surgical neck of the humerus. Incidence of AVN is less.

RoIe of Muscle Forces

• Anatomical Neck: These above muscles pull the fracture fragments in different directions leading to widespread displacements and angulations.
• Greater Tuberosity: Supraspinatus, external rotators are attached here and displace the fracture segments up.
• Lesser Tuberosity: Subscapularis inserted here which generates a deforming force and displaces medially.
• Shaft: It gives attachment to pectoralis major, which causes medial and internal rotation.

Categories of Fractures

There are four major categories of fractures. These are shown as below:

• A one-part fracture is fracture with minimal displacement.
• A two-part fracture is where one segment is displaced in relation to the other.
• A three-part fracture is where two segments are displaced in relation to the other two.
• A four-part fracture where all four major segments are displaced.

Clinical Features

The patient complains of pain, swelling and other features of fractures. Movements of the shoulder joint are grossly restricted.

Investigations

• Plain X-rays of the shoulder: Trauma series consists of AP, lateral, and axillary view of shoulder joint in scapular plane.
• Laminagrams to judge the articular defects.
• CT scan helps to study the fracture lines with greater accuracy.

Management

1.   Nonoperative Treatment

Indications

• Undisplaced fractures
• Surgical neck fractures
• Poor health
• Poor surgical risks
• Very old patients

2.   Conservative treatment

Conservative Treatment consists of rest, NSAIDs, sling, ice and heat therapy in the initial stages. U-slab and rarely, U-cast may be required in fractures with minimal displacement. Since 80 percent of the fractures are minimally displaced, early motion of the shoulder is the mainstay of treatment to prevent stiffness of the joint. Pendulum exercises, elevation, pulley, external and internal rotation and wall climbing exercises are some of the recommended methods, in the later stages.

3.   Operative Treatment

Hinterman et al advocate rigid internal fixation of displaced fracture of the proximal humerus in older patients with a blade-plate device and this provides sufficient primary stability to allow early functional treatment. Restoration of anatomy and biomechanics may contribute to a good functional outcome when compared with alternative methods of fixation or conservative methods.

Complications

• Joint stiffness is due to periarticular fibrosis.
• Malunion is due to the varying muscle forces.
• Avascular necrosis is seen in fracture of the anatomical neck.
• Nonunion of surgical neck.
• Myositis ossificans due to vigorous massage and treatment.

A Proximal Humerus Fracture is a typical damage to the neck. A Proximal Humerus Fracture happens when the football, of the ball-and-socket neck complex, is damaged. The fracture is actually at the top of the arm cuboid.  Accessible Physical Therapy Services offer services include the evaluation and treatment of acute and chronic musculoskeletal conditions. Call now for Best Treatment: (301) 552-8700

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