Nail osteosynthesis is performed to combine the high stability of rigid implants with the. Functional outcomes for surgically treated 3 and 4part. 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. Home rehabilitation exercises for a broken upper humerus. Nonoperative proximal humeral fracture rehabilitation. Bony healing occurs usually within 6 to 8 weeks in adults 2. Non displaced 2 part fracture good alignment does not involve an articular surface. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. 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. Early functional therapy should be enabled in order to prevent shoulder stiffness. A proximal humerus fracture is a crack or break in the top of your upper arm bone. They occur more commonly in elderly patients, after.
Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. 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. Nonoperative treatment of closed displaced midshaft clavicle fractures. Operative treatment and postoperative care were similar for all patients. This type of fracture may be caused by a fall, trauma from a car accident, or a sports injury. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Fractures of the proximal humerus are common, accounting for 5% of all fractures. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht.
The most useful rehabilitation protocol is the threephase system. This is an enhanced pdf from the journal of bone and joint surgery. Growth plate fractures were further classified based on sh classification 2, 16. The chart showing pdf series, word series, html series, scan qr codes. 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. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy. Humerus fracture upper arm fracture johns hopkins medicine. A comprehensive study of proximal humerus fractures and osteosynthesis in adult dr. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not.
Immediate physiotherapy following a proximal humerus fracture results in. Proximal humeral fractures figure 1 are common, particularly in the elderly. Proximal humeral fracture, operative treatment, physiotherapy, postoperative. Proximal humeral fracture twin boro physical therapy. Rehabilitation programs for nonoperative humeral fractures dr. Open access journal of novel physiotherapy and rehabilitation 104 issn 25736264 abstract background. Diversity of fracture types attenuates reliability of available classification systems. Return to normal function and motion may require 3 to 4 months overall goals. Early home physical therapy for my humerus fracture youtube. Proximal hip fracture open reductioninternal fixation and rehabilitation surgical indications and considerations anatomical considerations. 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. The proximal humeral physis contributes approximately 80% of the growth of the humerus.
Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. Although this case does not perfectly fit into headsplitting or impaction fracture categories, the fracture clearly involves a significant portion of the articular surface. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Further numbers are assigned according to fracture configuration with 3 representing. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Evidencebased protocols for phf rehabilitation are lacking and physiotherapists use a variety of interventions. A proximal humerus fracture is a break of the upper part of the bone of the arm. These fractures can be classified by where the break is, how many pieces it has broken into, and whether the. Increasing degrees of displacement and instability, as seen in conservatively managed neer three and fourpart fracture configurations, are associated with. The treatment of proximal humeral fracture in adults. 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. Effect of intramedullary nail and locking plate in the.
Operative versus nonoperative treatment for twopart surgical neck fractures of the proximal humerus. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. The shoulder joint is essentially a ball and socket joint. Shoulder arthroplasty for acute proximal humerus fracture. Surgical treatment for a proximal humerus fracture. The treatment of proximal humeral fracture in adults 02.
Jun 10, 2019 after a humerus fracture, your ability to move your shoulder, called range of motion, will be limited. After a humerus fracture, your ability to move your shoulder, called range of motion, will be limited. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Pdf strength recovery after proximal humeral fractures treated. The double series included 56 patients managed conservatively for fracture of the distal extremity of the humerus. The incidence and treatment trends of pediatric proximal. Pdf the aim of this study is to understand whether the isokinetic strength could be a valid objective data. Bony healing occurs usually within 6 to 8 weeks in adults.
The shoulder is a ball and socket joint and you have fractured the ball part. While the tuberosities were repaired, the supraspinatus, when present, was. Rehabilitation programs for operative and nonoperative. Approximately 8085% of proximal humerus fractures are nondisplaced or minimally displaced. Proximal humerus fracture shoulder 7 fracture care team. Proximal humeral fracture postsurgical rehabilitation protocol. Proximal humeral fracture postsurgical rehabilitation. Proximal humerus fractures phfs are common injuries particularly in older adults. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced. Proximal means it is the end of the bone that is closest to the body. 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.
Fractures in the shoulder area can involve any of the bones that form the shoulder, including the humerus or upper arm humeral fracture. Olerud p, ahrengart l, ponzer s, saving j, tidermark j. Early home physical therapy for my humerus fracture rob lovegreen. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. The humeral head is covered in articular cartilage and articulates. Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. 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. Proximal humerus shoulder fractures musculoskeletal. Internal fixation versus nonoperative treatment of displaced 3part proximal humeral fractures in elderly patients. Apr 05, 2016 hertel r, hempfing a, stiehler m, leunig m.
The shoulder is a ball and socket joint and you have fractured just below the ball part. 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. Management of proximal humeral fractures based on current. Post fracture proximal humerus rehabilitation guidelines. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. Proximal humerus fracture devascularizing the humeral head may require management by prosthesis. The combining of exercise and mobilisation produced further. In the elderly and adult population osteopenic bone can fracture from minimal trauma or as the result of a shoulder dislocation. 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. In younger patients, highenergy trauma is the cause of injury. 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. Due to variable stability of the fracture, check for specifications and precautions ordered by the. Oct 11, 2019 the profher proximal fracture of the humerus. Pdf rehabilitation of proximal humerus fractures a.
Most proximal humeral fractures occur in the elderly population. 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. 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 humeral fractures requiring surgical stabilization remain a therapeutic challenge, and a fully functioning joint. Fractures of the proximal humerus most commonly occur with falls onto an outstretched hand or directly onto the shoulder. 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. Symptoms include pain, swelling, and a decreased ability to move the shoulder.
A proximal humerus fracture usually occurs close to the shoulder joint and can be located at different levels with different fracture patterns. Stability of this joint is achieved by the surrounding ligaments. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Proximal humerus fracture east sussex healthcare nhs trust.
Nonoperative sling immobilization followed by progressive rehab indications most proximal humerus fractures can be treated nonoperatively including minimally displaced surgical and anatomic neck fractures. 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. Current concepts in treatment of proximal humerus fractures. 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. A proximal humeral upper arm bone fracture is a break in the upper aspect of the humerus, close to the ball and socket glenohumeral joint of the shoulder. Proximal humerus fractures phfs are common, particularly among older adults, and account for a large proportion of all fragility fractures 1. Open reduction internal fixation general principles. 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. Phase i 0 to 21 days begin elbow, wrist and hand active rom. The blood supply to the proximal humerus is a little unique, and thats where the treatment options vary. A proximal humerus fracture is a type of broken shoulder its a fracture of the bone that connects your shoulder to your elbow. Return to normal function and motion may require 4 months 6 months.
Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. 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. Twopart fractures the twopart fracture includes those proximal humeral fractures with a single displacement at. 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. Proximal humerus fractures phfs are common, particularly among older. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. 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. Twopart fractures of the proximal humerus may be impacted.
Extension and internal rotation not performed until 6 weeks 4. A humerus shaft fracture, on the other hand, is one that is localized at the mid portion of the upper arm. Recovery, proximal humerus fracture, adults, perspectives, mixed. 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. Treatment of proximal humeral fractures with im nails. An environmental scan of canadian physiotherapy practice patterns find, read and cite all. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Groups iv and v merge in the fourpart fracture where both. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Rehabilitation after proximal humeral fractures request pdf. Proximal humerus fractures are one of the commonest fractures accounting approximately 45% of the fracture attendance at the hospital. There is currently insufficient evidence to suggest superiority of one treatment option over the others. In older patients with proximal humeral fractures, reverse. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture.
In some cases, the broken proximal humerus must be surgically repaired or replaced. The proximal humerus is one of the bones in your shoulder joint. Humerus fractures functional union acceptable deformity. Proximal humerus fractures pediatric orthopaedic society of. The vast majority of proximal humeral fractures result from lowenergy trauma in presence of osteoporosis. There is also an impaction fracture of the glenoid. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Fractures of this region are common both with highenergy. Surgeons may use nails, plates, and screws to secure pieces of bone together. Recovery following proximal humerus fracture scholarship.
Coaptation splint temporary to provide initial comfort and. Axelina rehabilitation program of the shoulder joint, are the most commonly used regimen at. Rehabilitation is central to addressing the problems caused by the fracture. The hip is a ball and socket joint with the femoral head aligned towards the pelvic acetabulum. Maintain range of motion rom without displacing the proximal humerus fracture. Pdf arthroplasty for proximal humerus fractures grant. This protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Proximal humeral fractures are relatively uncommon fractures, accounting for 5% of all fractures at an incidence of 66100,000 person. 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. Incidence of proximal humeral fractures dramatically increased over the last decades. This information will guide you through the next 6 weeks of your rehabilitation. I think most would define successful fracture treatment as a functional union with minimal deformity. Bony healing occurs usually within 6 to 8 weeks in adults 3. This normally takes between 612 weeks to unite heal.
Electrotherapy or hydrotherapy does not enhance recovery. There are three main contributions to the vascular supply of the humeral head. The majority of proximal humerus fractures are lowenergy. 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. Maintain rom without displacing the proximal humerus fracture. No mechanical data exist to demonstrate benefit of adding suture to a plate and screw construct for limiting fracture displacement. Proximal humerus fracture book twin cities orthopedics. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. 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. 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. The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. It is through this groove that the terminal branches of the ascending division of the anterior.
Nonoperative treatment outpatient physiotherapy phase 1. Proximal hip fracture open reductioninternal fixation and. Two part fractures this is the commonest fracture pattern seen. Current concepts in locking plate fixation of proximal humerus. While nondisplaced fractures can be managed conservatively, displaced. Sep 02, 20 the incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Physical therapy prescription proximal humerus fracture 1216 weeks postop. The incidence is located after hip fracture and distal radius fracture 2. 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. These fractures tend to occur in older patients who are osteoporotic. Treatment methods will be described by fracture pattern. Proximal humerus fracture specific pt university of utah. 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.
The proximal humerus is important because it forms half of the shoulder joint. 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. 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. Around the world, this type of fracture remains a major challenge for treating surgeons. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Proximal humerus fractures are the third most common fracture in elderly patients. Proximal humeral fracture repair and rehabilitation. Pdf on jan 1, 2017, macintyre nj and others published rehabilitation of proximal humerus fractures.
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