Proximal humerus fracture in Adult
Classic history and presentation: An elderly patient presenting with arm pain after a ground level fall on an outstretched arm in an attempt to brace themselves.
Prevalence: Accounts for 5%-6% of all adult fractures.
- Age – most common in patients older than 65 years
- Sex / gender – 2:1 female-to-male ratio
Pathophysiology: Osseous components of the proximal humerus become fractured or displaced, usually secondary to direct trauma. Traditionally, proximal humerus fractures have been classified by their component fractured parts: humeral shaft, humeral head, greater tuberosity, and lesser tuberosity.
Grade / classification system:
In order to be classified as a fractured part, the fractured component needs to either be displaced greater than 1 cm or have angulation exceeding 45 degrees. The exception is the greater tuberosity, which is considered displaced at 5 mm.
- One-Part Fracture
- Fracture involves 1-4 parts
- No parts are displaced
- Two-Part Fracture
- Fracture involves 2-4 parts
- One part is displaced
- Three-Part Fracture
- Fracture involves 3-4 parts
- Two parts are displaced
- Four-Part Fracture
- Fracture involves more than 4 parts
- Three parts are displaced
S42.209A – Unspecified fracture of upper end of unspecified humerus, initial encounter for closed fracture
127286005 – Fracture of upper end of humerus
- Clavicle fracture
- Humeral shaft fracture
- Rotator cuff tear
- Shoulder dislocation
- Shoulder impingement syndrome
- Proximal biceps subluxation (see proximal biceps tendonitis)
- Acromioclavicular joint separation
- Lesser tuberosity avulsion fracture
- Greater tuberosity avulsion fracture
- Pathologic fracture of the proximal humerus