Proximal humeral fracture (summary)

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This is a basic article for medical students and other non-radiologists

Proximal humeral fractures are a heterogeneous group of fractures that include everything from relatively simple transverse fractures of the surgical neck of the humerus, to complex, displaced, multi-part fractures of the proximal humerus that extend into the shoulder joint. The shoulder is a hugely important joint and fractures of the proximal humerus can be devastating to quality of life.

Reference article

This is a summary article. For more information, you can read a more in-depth reference article: proximal humeral fracture.

Summary

  • anatomy
  • epidemiology
    • predominantly older women
  • presentation
    • pain and reduced range of motion of the affected shoulder
    • possible distal neurovascular compromise
  • pathophysiology
    • often occur secondary to direct trauma
    • associated with reduced bone density (osteoporosis: older females)
    • surgical neck of humerus commonly involved
    • may extend to involve the joint
  • investigation
    • shoulder radiograph for diagnosis
    • CT for accurate assessment of complex intra-articular fractures
  • treatment
    • treatment depends on fracture type, but often collar-and-cuff
    • prognosis worse if it involves the joint

Radiographic features

Plain radiograph

The fracture will be demonstrated as a lucency across the proximal humerus. The cortex of the humerus may have a step, or a lesser degree of cortical irregularity. There may be some angulation at the fracture.

The fracture may extend into the joint and there may be associated dislocation.

Medical student radiology curriculum