Surgical treatment options for proximal humerus fractures the 60s to 70s. Proximal humeral fractures are the most common of all humeral fractures approximately 45% 14 and account for 4% to 5% of all fractures. A and b, initial radiographs show comminuted surgical neck fracture with. 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. Open reduction and internal fixation orif orif is the most frequently used method of surgical treatment of proximal humeral fractures. Immediate physiotherapy following a proximal humerus fracture results in faster recovery with maximal functional benefit being achieved at one year and requires fewer treatment sessions 9 versus 14 treatments, groupa and b respectively. Proximal humerus fractures account for 45% of all fractures and are the third most common fracture in the elderly behind fractures of the distal radius and hip horak and nilsson, 1975.
Proximal humerus fracture east sussex healthcare nhs trust. We undertook a prospective, controlled trial which compared two rehabilitation programmes for 86 patients who sustained twopart fractures of the proximal humerus. Proximal humeral fractures phfs are among the most. Anatomic or reverse shoulder arthroplasty is often indicated in the elderly 2, 3, 4 but is a treatment of last resort in younger patients, in whom open reduction and internal fixation orif is.
Rehabilitation guidelines are proposed to enhance patient satisfaction and provide a framework for physical therapists. This nerve is the most commonly injured nerve in proximal humerus fractures due to its location close to the proximal humerus. Malunion of a proximal humerus fracture is difficult to manage once bone union has been. Nonoperative treatment of closed displaced midshaft clavicle fractures. The goal of treatment for proximal humerus fractures. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. A limited goal strategy should be agreed upon regardless of treatment choice. Besides humans, the barbary macaques are the only freeliving primates in europe, and besides geriatric patients with proximal humerus. Proximal humerus fracture nonoperative jason dieterle, do considerations. Interventions for treating proximal humeral fractures in adults. Sling was applied, and isometric and pendulum exercises were begun 4 days after injury. Extension and internal rotation not performed until 6 weeks 4. Pdf arthroplasty for proximal humerus fractures grant.
Symptoms include pain, swelling, and a decreased ability to move the shoulder. Proximal humerus fractures includes everything the orthopedic surgeon. Evidencebased protocols for phf rehabilitation are lacking and physiotherapists use a variety of interventions. Conclusions these results suggest that rsa treatment of proximal humeral fractures with 3part or 4part displaced fragments in elderly patients. Proximal humeral fracture radiology reference article. We describe the percutaneous fixation of proximal humerus which is not widely used but is a cost effective, less invasive and comparable to other techniques with regard to results. The goal of treatment is to reduce pain and regain function.
Internal fixation versus nonoperative treatment of displaced 3part proximal humeral fractures in elderly patients. Fractures involving the attachments of the rotator cuff. Proximal humerus fractures in the geriatric population. Aug 19, 2017 the epidemiology of proximal humerus fractures. Aug 21, 2020 proximal humeral fractures are strongly correlated to osteoporosis and common among older patients. Looking at the 3d reconstruction, would you advise on starting physiotherapy or keep the shoulder on sling. Proximal humerus fractures are rare in paediatric traumatology. Physiotherapy protocol for the profher trial the profher. Although nonsurgical treatment techniques have been used and can be used in much less common situations, this book focuses mainly on current surgical treatment techniques. Multiple options exist for treating displaced fractures, without a clear advantage of any one method for a given fracture type. Conservative treatment is the treatment of choice for epiphyseal and metaphyseal fractures of the proximal humerus in children 6, and includes different therapeutic options.
Proximal humerus fracture an overview sciencedirect topics. An environmental scan of canadian physiotherapy practice patterns published. Pdf rehabilitation of proximal humerus fractures a scoping. Our results show that patients with twopart fractures of the proximal humerus who begin immediate physiotherapy, experience less pain. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Proximal means it is the end of the bone that is closest to the body. At each visit, patients were asked whether they needed analgesics or whether they were pain free. The predominance of impacted, nondisplaced surgical neck fractures and conservative treatment no longer systematically corresponds to most of the complex, displaced fractures in osteoporotic bone.
Ortho fraktur proximal humerus dextra arm shoulder. Institute for orthopaedic surgery medical staff northwest. Here we will look at the different types of proximal humerus fractures, the common causes, treatment options and the recovery process including possible complications. Proximal humerus fractures phfs are common, particularly among older adults. Conservative treatment, plate fixation, or prosthesis for proximal. Pdf proximal humerus fractures current treatment options.
Pdf conservative versus surgical management of proximal. Pdf proximal humeral fracture treatment in adults martin. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Neers criteria, displaced two, three and fourpart proximal humerus fractures have been recognized as potentially bene. There are many ways of treating different kinds of proximal humerus fractures. Pdf practice guidelines for proximal humeral fractures. Proximal humerus fractures acta chirurgiae orthopaedicae et. In 1998 there were 110 000 ph fractures in the united kingdom uk and epidemiological studies indicate that the ph fracture incidence is increasing. Jul 18, 2019 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. This is a ct scan of 4 weeks old proximal humerus fracture treated conservatively. No proximal humerus fracture treatment method conservative treatment, internal fixation, etc. Nonoperative care is usually chosen when the fracture is stable, minimally displaced or the patient is not a good candidate for surgery. Fractures of proximal humerus account for 30% to 40% of all humeral fractures. Treatment of proximal humeral fractures has been the subject of much controversy and confusion this is because of the complexity of these injuries, fracture displacement are difficult to see without careful radiographic views and associated soft tissue injuries.
Proximal humerus fractures sometimes result in stiffness of the shoulder, elbow, or hand. Proximal humerus fracture is the third most common fracture type. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Ortho fraktur proximal humerus dextra free download as powerpoint presentation.
Evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the. Interventions for treating proximal humeral fractures in. A proximal humerus fracture is a break of the upper part of the bone of the arm. Surgical treatment of three and fourpart proximal humeral. Proximal humerus fractures phfs are common injuries particularly in older adults. Most proximal humeral fractures do not benefit from surgery, but surgery may be required in the most complex fractures. Nonoperative proximal humeral fracture rehabilitation protocol. Pdf find, read and cite all the research you need on.
Only two of them were r ct s that compared oper ative and non operative treatm ent kristiansen and kofoed. Proximal humerus fracture nonoperative mammoth orthopedic. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. Evaluation and management proximal humerus fractures include everything an orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. 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. Post fracture proximal humerus rehabilitation guidelines. Depending on the severity of the fracture, the patient may have significant loss of rom in forward flex, abd and er. Pdf rehabilitation after twopart fractures of the neck of the. Proximal humerus fractures evaluation and management.
Challenges in the treatment of proximal humeral fractures are rate of operative treatment increased by 25. If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please contact the fracture care team for advice. Proximal humerus fracture book twin cities orthopedics. 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. This fracture would be treated with reverse total shoulder arthroplasty rather than orif. 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 head is associated with. Fractures of the proximal humerus are important because they can damage the surface of the shoulder joint, leading to painful arthritis. Such stiffness often requires physical therapy to help get back to normal motion. Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory. Following this type of injury the main aim is to regain enough movement to perform day to day activities and help may be required initially. Pdf rehabilitation of proximal humerus fractures a.
Operative versus nonoperative treatment for twopart surgical neck fractures of the proximal humerus. Dines, md patients with 4part phfs with constant scores ranging from summary. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Non displaced 2 part fracture good alignment does not involve an articular surface. Additionally, fractures of the shoulder can bring about nerve injuries or other nerve conditions such as carpal tunnel syndrome. Proximal humerus fractures in the geriatric population are an opportunity to institute treatment which has been shown to decrease subsequent fractures and their resultant morbidity. Humeral headsplit fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint.
These fractures can also affect both the strength and range of motion of the arm, leading to diminished function of the arm. Feb 01, 20 in contrast to proximal humeral fractures that do not involve the tuberosities, three and fourpart fractures are usually treated surgically. Bony healing occurs usually within 6 to 8 weeks in adults 3. The western world faces an explosion in the number of patients who will fracture their proximal humerus ph as a result of the rapidly changing demographics and the increase in osteoporosis. Surgical vs nonsurgical treatment of adults with displaced.
Cureus a novel technique of proximal humerus fixation. 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. Goals include an adequate reduction and stable fixation to initiate early motion and rehabilitation. Proximal humerus fracture nonoperative three times per day home exercise program including.
The salterharris type 34 fractures and the epiphyseal fractures associated with epiphyseal dislocation are very rare 8. Flow of patients in the proximal fracture of the humerus evaluation by randomization trial. Although nonoperative treatment techniques are addressed and can be. Proximal humerus fractures will heal, typically within 612. Instituting a fls to manage these patients may be the most efficient step in improving bone health and improving longterm osteoporosis outcomes. Home rehabilitation exercises for a broken upper humerus. Open access journal of novel physiotherapy and rehabilitation 104 issn 25736264 abstract background. Signs and symptoms a fracture of the proximal humerus causes pain in the shoulder area. The majority of proximal humerus fractures are treated nonoperatively with good functional results. Proximal humerus fractures are often linked to shoulder stiffness. 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. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op.
Nonsensus in the treatment of proximal humerus fractures the bmj. Ref olerud p, ahrengart l, ponzer s, saving j, tidermark j. Rehabilitation after twopart fractures of the neck of the. The management, including surgical intervention, of these fractures varies widely.
Perform frequent gentle exercise to prevent adhesion formation. Although nonsurgical treatment techniques have been used and can be used in much less common situations, this book focuses mainly on current surgical treatment. Proximal humerus fractures in children and adolescents. Jan 25, 2018 proximal humerus fractures account for 6% of all fractures in the western world. Operative versus nonoperative treatment for 2part proximal. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2.
Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Patients were randomised either to receive immediate physiotherapy within one week group a or delayed physiotherapy after three weeks. Treatment for displaced fractures should consider the patients level of independence, bone quality, and surgical risk factors. The purpose of this study was to investigate recent trends in the incidence and treatment of proximal humerus fractures phfs in a crosssectional elderly population. Nonoperative management of proximal humerus fractures. It does not replace the opinion, discussion, and treatment from a trained medical professional. The shoulder joint is essentially a ball and socket joint. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries. Proximal humerus fractures evaluation and management lynn. Greiwe, in shoulder and elbow trauma and its complications, 2015 5. Pdf proximal humerus fractures represent an increasing challenge for the health system. With an aging population, fragility fractures including injuries to the proximal humerus continue to rise in the united states.
303 511 1292 619 621 210 1639 1026 1726 562 1786 344 931 1141 444 201 1777 1418 974 1281