Proximal Humeral Fractures

Proximal Humeral Fractures
May 20, 2016

proximal_humerus_fracture_0-large“Almost 5% of the fractures are contributed by proximal humeral fractures as osteoporosis, falls on shoulder or collision in traumatic car accidents are not uncommon”, expresses Dr. Gupta. “Being in this field for more than 20 years with having graduated as MBBS and MS in Orthopedics from All India Institute of Medical Sciences I still feel awe with each case and learn that each debilitating condition holds something unique in its approach.” says Dr. Gupta.

“Proximal Humeral Fractures are broken bones on the upper end of the humerus bone that is connected to the shoulder joint via the arm. Immediate and intense swelling with extreme pain on the shoulder is enough to alert the patient that the bone might have been fractured and/or displaced.”

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“Though I have been to Germany and USA for further studies and prognosis in the field of upper extremity and brought back varying international techniques I believe that lack of adequate knowledge in the patients is reason enough to trigger off anxiety and make matters worse”, quotes Dr. Vikas.

“As regards proximal humeral fractures it is essential to understand that they are treated like any other body fractures with initially conservative techniques and a sling to align the bone that has broken but not displaced. In severe cases of displaced fractures, reduction and replacement methodology is adopted with implantation or grafting technique,” refers Dr. Gupta.

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“We undertake the patient’s age, bone displacement, type of injury or trauma sustained and only after a complete evaluation and imaging tests reach to the kind of treatment technique to be adopted. With gentle therapy exercises the rehabilitation of the patient is taken care of, that provides back the lost strength and mobility in the shoulder.”

At present, an integral part of  Max Healthcare Dr. Gupta finally asserts that, “Patients should stress on the skill and proficiency of the surgeon else they might have to suffer a lifetime with an impaired shoulder.”  

 

FAQ – Proximal Humeral Fractures

Humerus is the longer bone in the arm with two ends. The distal end of the humerus makes it a part of the elbow joint whereas the proximal end makes it a part of shoulder joint. When due to any traumatic injury the humerus bone at the end of the shoulder joint gets broken it is termed as Proximal Humeral Fracture.
The common causes that contribute to proximal humeral fractures are falls that make the patient land directly on the shoulder or an outstretched hand, a forceful collision or a car accident or patients suffering from osteoporosis( when the tissues of the bone become weak and can easily break).
The person who might have sustained a proximal humeral fracture will feel immediate swelling and bruising in the shoulder region after the injury, accompanied by an enervating pain. The person may experience numbness in the arm, forearm and hand region and severely restricted shoulder movements with the shape of the bone changing its contours.
After a thorough physical examination the orthopedic will have an imaging test done of the affected shoulder along with MRI or CT Scan to determine if the patient has sustained and soft tissue injury too. Once the orthopedics is assured that it indeed is a proximal humeral fracture he will move further ahead with the treatment.
Proximal Humeral fractures are of two types: Non Displaced: in this type of fracture the bones are separated but are not out of their positions. Displaced: in this type of fracture the bones are separated as well as shift from their place.
To a large extent no, these fractures cannot be prevented but yes to a certain extent if precautions are taken they can be decreased. For osteoporosis patients who could sustain proximal humeral fracture, regular intake of vitamins and minerals can help to curb their bone deficiency, for athletes who are prone to falls and injuries preventive guards can be worn to minimize the impact of the injury or fall and older patients who could fall due to proper balance strength should use assistive equipments.

The factors that determine the course of treatment techniques are the type of fractures i.e. displaced or nondisplaced that the shoulder has sustained, the severity of their impact and the change in their angulations.

To start with nondisplaced fractures are treated with conservative techniques to provide relief that are inclusive of oral anti inflammatory drugs and therapy exercises on one hand and putting the shoulder in a sling or external brace to immobilize the bones so that they are properly healed, on the other.

The surgical techniques that are taken up as treatment options to repair the bones are: Implantation Technique- the broken bones are braced together by inserting metal screws or pins or held together by metal plates or implanting a rod. The shoulder is then put in a sling to immobilize the arm and shoulder movement to enable proper alignment of the bones. These are taken up by reduction percutaneous fixation techniques including K- wire, screw fixation or combination techniques or open reduction and internal fixation technique which enables reduction in fracture and rigid fixation.

Replacement Technique- in severe cases of damage to the bones or multiple fractures the surgeon might adopt replacement technique where the damaged area might be replaced by an artificial part to enable normal functioning. It might be taken up as total, partial, reverse arthroplasty or hemiarthroplasty as suitable to the damage.

Life is not very easy to start with, after treatment of the fracture. There is a certain period for which the shoulder is immobilized and then rehabilitation program is introduced which involves gentle therapy exercises to relieve the stressed muscles and tissues. Within months though the patient can return to his normal activities as slowly the shoulder regains strength and motion improvement is facilitated.
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