The arm is made up of the humerus bone. The upper end of the humerus is called the proximal humerus. It has a head, neck and a shaft which is the body of the bone. The head of the humerus is the ball of the shoulder joint. The upper end of the humerus also has 2 prominences one on the front called the lesser tuberosity and 1 on the side called the greater tuberosity. These are sites of attachment for tendons that move the shoulder. The upper end of the humerus is a commonly fractured bone. The proximal humerus articulates with the socket of the shoulder blade called the glenoid.
The proximal humerus can break in several ways. The bone can crack slightly or can break into 2,3, 4 or more pieces. Proximal humerus fractures are generally due to automobile accidents, direct blow on the arm or fall on an outstretched arm during sports, climbing stairs, etc.
The symptoms of a proximal humerus fracture include intense pain in the shoulder, bruising and swelling. Your fractured shoulder may not appear swollen compared to your other arm. You may experience numbness or weakness in the shoulders, fingers, or wrist. You may be unable to rotate your arm. It is rare for the broken bone to stick out through the skin or for the wound to penetrate down to the broken bone.
Medical history will be recorded and a physical examination will be conducted and x-rays ordered to evaluate the fracture. Often a CT scan may be needed to further evaluate the location of the fracture, the number of pieces, the bone quality and the location of the joint.
Usually, people with proximal humerus fractures are immediately rushed to the emergency room for treatment. Treatment of proximal humerus fractures aim at putting back the broken bones into position and preventing them from moving out of place until they are completely healed.
In case the fracture is in only two pieces, and is not out of place, Dr Bala might treat it with just an arm sling for comfort and early mobilisation. Dr Bala will closely monitor the healing of the fracture with x-rays. If the fracture shifts in position, you may need to undergo surgery to fix the bones back together.
When the bone is broken into more than 2 pieces or significantly moved out of place or angulated, surgery is usually required. During surgery (Open reduction and internal fixation), the bone fragments are repositioned into their normal alignment. They are held together with screws and metal plates attached to the outer surface of the bone or on occasion a nail down the middle of the bone. Proximal humerus fractures are usually approached from the front or side of the shoulder. This surgery can involve working very close to important blood vessels and nerves that supply your shoulder and Dr Bala takes care to visualize and protect these structures. The incision is sutured firmly and a sling is provided to facilitate healing. In the event you may have a tattoo on the shoulder Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.
Following the surgery, a sling is usually required.
In young patients, fixation is always attempted. Rarely for non-reconstructable fractures with thin bone in multiple pieces, or salvage of a failed fixation of proximal humerus fracture, a reverse shoulder replacement is done with a special stem for fractured bone to be able to attach the tendons back.
Dr Bala specializes in salvage of failed surgery of shoulder fractures, complications of poorly managed fractures and neglected fractures.