A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. Proximal means it is the end of the bone that is closest to the body. Fractures in the shoulder area can involve any of the bones that form the shoulder, including the humerus or upper arm humeral fracture. A comprehensive study of proximal humerus fractures and osteosynthesis in adult dr. Home rehabilitation exercises for a broken upper humerus. Proximal humeral fracture postsurgical rehabilitation protocol. Bony healing occurs usually within 6 to 8 weeks in adults 3. Proximal humeral fractures figure 1 are common, particularly in the elderly. Rehabilitation after proximal humeral fractures request pdf. In younger patients, highenergy trauma is the cause of injury. Post fracture proximal humerus rehabilitation guidelines.
Functional outcomes for surgically treated 3 and 4part. Early functional therapy should be enabled in order to prevent shoulder stiffness. Most proximal humeral fractures occur in the elderly population. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. The chart showing pdf series, word series, html series, scan qr codes. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Although this case does not perfectly fit into headsplitting or impaction fracture categories, the fracture clearly involves a significant portion of the articular surface. Recovery following proximal humerus fracture scholarship.
Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. Twopart fractures of the proximal humerus may be impacted. A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patientrelated factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Proximal humeral fracture twin boro physical therapy. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly.
They occur more commonly in elderly patients, after. Proximal hip fracture open reductioninternal fixation and rehabilitation surgical indications and considerations anatomical considerations. Nonoperative sling immobilization followed by progressive rehab indications most proximal humerus fractures can be treated nonoperatively including minimally displaced surgical and anatomic neck fractures. Return to normal function and motion may require 3 to 4 months overall goals. Further numbers are assigned according to fracture configuration with 3 representing. Open access journal of novel physiotherapy and rehabilitation 104 issn 25736264 abstract background. Phase i 0 to 21 days begin elbow, wrist and hand active rom. Olerud p, ahrengart l, ponzer s, saving j, tidermark j. Current concepts in treatment of proximal humerus fractures. Maintain range of motion rom without displacing the proximal humerus fracture. Proximal humerus fracture east sussex healthcare nhs trust. In older patients with proximal humeral fractures, reverse.
This is an enhanced pdf from the journal of bone and joint surgery. The treatment of proximal humeral fracture in adults. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. However, conserva tive therapy regimes are not reserved to simple fractures alone, as the functional outcome primarily depends on age and less on deformity 2. Shoulder arthroplasty for acute proximal humerus fracture. The incidence and treatment trends of pediatric proximal. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. While the tuberosities were repaired, the supraspinatus, when present, was. In older patients with proximal humeral fractures, reverse shoulder arthroplasty and nonoperative treatment did not differ for overall function or quality of life at 12 months. Jun 10, 2019 after a humerus fracture, your ability to move your shoulder, called range of motion, will be limited. Twopart fractures the twopart fracture includes those proximal humeral fractures with a single displacement at.
A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm. Apr 05, 2016 hertel r, hempfing a, stiehler m, leunig m. In some cases, the broken proximal humerus must be surgically repaired or replaced. These fractures can be classified by where the break is, how many pieces it has broken into, and whether the. Pdf strength recovery after proximal humeral fractures treated. Evidencebased protocols for phf rehabilitation are lacking and physiotherapists use a variety of interventions. Internal fixation versus nonoperative treatment of displaced 3part proximal humeral fractures in elderly patients. Fracture and treatment type the proximal humerus fractures were classified by the aoclassification for epiphyseal 11e1 or 11e2, metaphyseal 11m3, and metaphysisdiaphysis junction groups 27. Nonoperative treatment of closed displaced midshaft clavicle fractures. The most useful rehabilitation protocol is the threephase system. Gain adequate strength in the rotator cuff to allow for humeral head depression necessary to avoid impingement strengthen scapular musculature to allow for proper scapulohumeral rhythm intervention. Proximal humerus fractures phfs are common, particularly among older adults, and account for a large proportion of all fragility fractures 1.
After a humerus fracture, your ability to move your shoulder, called range of motion, will be limited. Proximal hip fracture open reductioninternal fixation and. There are three main contributions to the vascular supply of the humeral head. Bony healing occurs usually within 6 to 8 weeks in adults. Operative treatment and postoperative care were similar for all patients. The treatment of proximal humeral fracture in adults 02. Increasing degrees of displacement and instability, as seen in conservatively managed neer three and fourpart fracture configurations, are associated with. A patients guide to adult proximal humerus shoulder fractures adult proximal humerus shoulder fractures anatomy the proximal humerus is the top portion of the humerus upper arm bone. Growth plate fractures were further classified based on sh classification 2, 16. Nail osteosynthesis is performed to combine the high stability of rigid implants with the.
Effect of intramedullary nail and locking plate in the. The blood supply to the proximal humerus is a little unique, and thats where the treatment options vary. Axelina rehabilitation program of the shoulder joint, are the most commonly used regimen at. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. Approximately 8085% of proximal humerus fractures are nondisplaced or minimally displaced. Proximal humerus fracture devascularizing the humeral head may require management by prosthesis. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not. Stability of this joint is achieved by the surrounding ligaments.
Due to variable stability of the fracture, check for specifications and precautions ordered by the. The proximal humerus is important because it forms half of the shoulder joint. Tensionrelieving rotator cuff sutures do not add stability to the repair of 3part proximal humerus fractures. Proximal humerus fractures phfs are common injuries particularly in older adults. Proximal humeral fractures requiring surgical stabilization remain a therapeutic challenge, and a fully functioning joint. Hemiarthroplasty is a logical attitude in such cases, but analysis of functional results and complications has identified a certain number of risk factors limiting indications. Proximal humeral fracture postsurgical rehabilitation. Fractures of the proximal humerus account for 4%5% of the whole body bone fractures 1,2, and proximal humerus fracture phf is the third common injury among the older people 3. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints.
Return to normal function and motion may require 4 months 6 months. Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Nonoperative treatment outpatient physiotherapy phase 1. Proximal humerus shoulder fractures musculoskeletal. Proximal humeral fracture, intramedullary nail, locking plate, internal fixation, metaanalysis background phf is the third common limb fracture, accounting for 4 to 5% of total body fractures 1. An environmental scan of canadian physiotherapy practice patterns find, read and cite all. Weeks 24 rom cervical, elbow and wrist rom pendulum exercises instruct in home program strengthening no cuff strengthening begin and instruct in program of postural correction may begin scapular retraction and depression. The proximal humeral physis contributes approximately 80% of the growth of the humerus. Rehabilitation programs for operative and nonoperative. Immediate physiotherapy following a proximal humerus fracture results in. Mar, 2017 materials and methods fortythree patients with a mean age of 78 years with an acute proximal humerus fracture were treated with a delta reversed shoulder prosthesis depuy, saint priest, france. Physical therapy prescription proximal humerus fracture 1216 weeks postop. Operative versus nonoperative treatment for twopart surgical neck fractures of the proximal humerus.
There is currently insufficient evidence to suggest superiority of one treatment option over the others. Proximal humeral fracture, operative treatment, physiotherapy, postoperative. These fractures tend to occur in older patients who are osteoporotic. A proximal humerus fracture is a crack or break in the top of your upper arm bone. Nonoperative proximal humeral fracture rehabilitation. Proximal humerus fracture book twin cities orthopedics. Humerus fracture upper arm fracture johns hopkins medicine. The proximal humerus is one of the bones in your shoulder joint.
Oct 11, 2019 the profher proximal fracture of the humerus. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Electrotherapy or hydrotherapy does not enhance recovery. Oct 01, 2011 proximal humerus fractures trail behind only femoral neck and distal radius as the third most common fracture in patients older than 65 years. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. There is also an impaction fracture of the glenoid.
Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. The shoulder joint is essentially a ball and socket joint. Surgeons may use nails, plates, and screws to secure pieces of bone together. A proximal humerus fracture is a type of broken shoulder its a fracture of the bone that connects your shoulder to your elbow. This type of fracture may be caused by a fall, trauma from a car accident, or a sports injury. Evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and costeffectiveness of surgical compared with nonsurgical treatment for proximal fracture of the humerus in adults. Fractures of the proximal humerus are common, accounting for 5% of all fractures. The majority of proximal humerus fractures are lowenergy. Here we will look at the different types of proximal humerus fractures, the common causes, treatment options and the recovery process including possible complications. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2.
This protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. The shoulder is a ball and socket joint and you have fractured the ball part. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. Proximal fractures are classified into one of four types of fractures based on the displacement of the greater tubercle, the lesser tubercle, the surgical neck, and the anatomical neck, which are the four parts of the proximal humerus, with fracture displacement being defined as at least one centimeter of separation or an angulation greater. Proximal humeral fractures are relatively uncommon fractures, accounting for 5% of all fractures at an incidence of 66100,000 person. Proximal humeral fractures are commonly encountered in the emergency department neer classification is the most widely used approach to fracture description while radiographs and cts are frequently used in the setting of proximal humeral fractures, mri is rarely used avascular necrosis of the humeral.
Pdf rehabilitation of proximal humerus fractures a. Early home physical therapy for my humerus fracture rob lovegreen. Symptoms include pain, swelling, and a decreased ability to move the shoulder. These include translated twopart fractures of the proximal humerus with minimal alteration of the neckshaft angle, valgus and varus impacted fractures of the proximal humerus 7, 8. Rehabilitation programs for nonoperative humeral fractures dr.
Bony healing occurs usually within 6 to 8 weeks in adults 2. Management of proximal humeral fractures based on current. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. The hip is a ball and socket joint with the femoral head aligned towards the pelvic acetabulum. In most cases a proximal humerus fracture doed not require surgical intervention but is instead treated with a period of immobilisation in a sling and a rehabilitation programme. Rehabilitation is central to addressing the problems caused by the fracture. Humerus fracture recovery exercises typically begin with activities to improve shoulder movement, three weeks after injury, according to rehabilitation guidelines recommended by mammoth orthopedic institute. The shoulder is a ball and socket joint and you have fractured just below the ball part. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. Current concepts in locking plate fixation of proximal humerus.
Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Diversity of fracture types attenuates reliability of available classification systems. Groups iv and v merge in the fourpart fracture where both. Surgical treatment for a proximal humerus fracture.
Pdf arthroplasty for proximal humerus fractures grant. Extension and internal rotation not performed until 6 weeks 4. Non displaced 2 part fracture good alignment does not involve an articular surface. In the elderly and adult population osteopenic bone can fracture from minimal trauma or as the result of a shoulder dislocation. The double series included 56 patients managed conservatively for fracture of the distal extremity of the humerus. This normally takes between 612 weeks to unite heal. Open reduction internal fixation general principles. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. Maintain rom without displacing the proximal humerus fracture.
Proximal humeral fracture repair and rehabilitation. Recovery, proximal humerus fracture, adults, perspectives, mixed. A proximal humerus fracture is a break of the upper part of the bone of the arm. Sep 02, 20 the incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Proximal humerus fractures pediatric orthopaedic society of. If a fracture or fracture repair is stable, then therapy should be started early. Nonoperative proximal humeral fracture rehabilitation protocol general principles.
Proximal humerus fractures phfs are common, particularly among older. Humerus fractures functional union acceptable deformity. Pdf the aim of this study is to understand whether the isokinetic strength could be a valid objective data. Nonoperative treatment of proximal humerus fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Proximal humerus fracture shoulder 7 fracture care team. Pdf on jan 1, 2017, macintyre nj and others published rehabilitation of proximal humerus fractures. Coaptation splint temporary to provide initial comfort and. Incidence of proximal humeral fractures dramatically increased over the last decades. Physical therapy is a part of any treatment approach to proximal humeral fractures with few guidelines available as to staging of interventions to maximize range. Proximal humerus fracture specific pt university of utah. The incidence is located after hip fracture and distal radius fracture 2. It is through this groove that the terminal branches of the ascending division of the anterior. Recent epidemiological studies expect a rather stagnant incidence. The humeral head is covered in articular cartilage and articulates.
Two part fractures this is the commonest fracture pattern seen. While nondisplaced fractures can be managed conservatively, displaced. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Fractures of this region are common both with highenergy. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. Around the world, this type of fracture remains a major challenge for treating surgeons. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. No mechanical data exist to demonstrate benefit of adding suture to a plate and screw construct for limiting fracture displacement. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs.
The upper part of the humerus forms part of the shoulder joint and the lower part of the bone helps form part of the elbow joint. Early home physical therapy for my humerus fracture youtube. A proximal humerus fracture is when the top part of the upper arm bone, which is shaped like a ball, is broken. Physiotherapeutic interventions and rehabilitation. Fractures of the proximal humerus most commonly occur with falls onto an outstretched hand or directly onto the shoulder. The vast majority of proximal humeral fractures result from lowenergy trauma in presence of osteoporosis. The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Treatment methods will be described by fracture pattern.
Proximal humerus fractures are one of the commonest fractures accounting approximately 45% of the fracture attendance at the hospital. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Antti launonen and team assess surgery compared with locking plate and nonoperative treatment for displaced twopart proximal humerus fractures in a superiority, assessorblinded, randomized trial in six hospitals in finland, estonia, sweden, and denmark. Proximal humerus fractures are described as 11 fractures with further subdivision into unifocal extraarticular denoted as 11a, bifocal extraarticular denoted as 11b and articular fractures denoted as 11c. I think most would define successful fracture treatment as a functional union with minimal deformity. Treatment of proximal humeral fractures with im nails. The combining of exercise and mobilisation produced further. Conservative treatment of fractures of the distal extremity of the humerus in the elderly is a timehonored attitude, which used mainly to be reserved to fractures. In general, management of proximal humerus fractures depends on the patients age, fracture type, level of displacement, bone quality, handdominance, lifestyle, and medical comorbidities. This information will guide you through the next 6 weeks of your rehabilitation.
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