These fractures tend to occur in older patients who are osteoporotic. The pdf of the article you requested follows this cover page. A humerus fracture is a break of the humerus bone in the upper arm. Microsoft word infosheet proximal humerus fracture2 author. Rehabilitation of the elbow scottsdale sports medicine. Immediate physiotherapy following a proximal humerus fracture results. There is yet to be a definitive, easily used classification for proximal humeral fractures. Here we will look at the different types of proximal humerus fractures, the common causes, treatment options and the recovery process including possible complications. Eightyeight patients aged 60 years or older with displaced more than 1 cm or 45 degrees 2part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1. Pdf on jan 1, 2017, macintyre nj and others published rehabilitation of proximal humerus fractures. The vast majority of proximal humerus fractures can be treated with some functional braces or casting.
Charles neers system from 1970 11, figure 1 is still the most widely used. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Increase rom while protecting the fracture site you can be slightly more. The proximal humerus is one of the bones in your shoulder joint. Olecranon fracture open reduction and internal fixation.
Mar 02, 2017 a proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. Restoration of function in this patient population is the ultimate goal. Bony healing occurs usually within 6 to 8 weeks in adults 2. The incidence of proximal humerus fractures is 4% to 5% of 1all fractures. A proximal humerus fracture is a common injury to the shoulder.
Twopart surgical neck fracture of the proximal humerus with posteromedial communition fixation using a combination of and intramedullary cortical strut and plate. 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. Operative versus nonoperative treatment for 2part proximal. Complex displaced proximal humerus fractures are frequently treated with a fracture prosthesis. Sports medicine physical therapy rehabilitation protocols. This normally takes between 612 weeks to unite heal. Fashion removable longarm splint holding the elbow in 90 degrees of. 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.
The shoulder is a ball and socket joint and you have fractured just below the ball part. If a fracture or fracture repair is stable, then therapy should be started early. Patients typically start physical therapy after the 4 week. In some complex fractures, a cat scan may be necessary to get a 3dimensional view of the shoulder to better assess the. Distal humerus fractures orthopaedic trauma association. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Nov 03, 2017 twopart surgical neck fracture of the proximal humerus with posteromedial communition fixation using a combination of and intramedullary cortical strut and plate. A proximal humerus fracture is a type of broken shoulder its a fracture of the bone that connects your shoulder to your elbow. A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Evaluation and management of pediatric proximal humerus fractures. Original article tips and tricks of long helical philos. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Distal humerus orif fracture early motion therapy protocol. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op.
Once the fracture has healed sufficiently, physical therapy is usually started with a gradual return to normal daily functions. The type of fracture will be determined by taking several xrays of the shoulder. It is the most common fracture of the shoulder region. Other than using a walker for balance, she is in good health and independent living with us. Distal humerus fractures orthopaedic trauma association ota. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration.
It is the third most common fracture that occurs in individuals over the age of 65, after. Web of science, proquest, file, society of automotive engineers. The proximal humerus is important because it forms half of the shoulder joint. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. Proximal humerus fracture book twin cities orthopedics. Intramedullary nailing versus percutaneous pin fixation of pediatric proximal humerus fractures. The vast majority of patients with proximal humerus fractures do not require longterm followup fractures that involved the physis rarely result in a growth arrest and, as such, do not routinely require long term followup.
Splint to be worn full time except for when performing therapy exercises for the rst 6 weeks. Operative versus nonoperative treatment for twopart surgical neck fractures of the proximal humerus. Nonoperative treatment of closed displaced midshaft clavicle fractures. Like all bones in the body, the proximal end of the humerus will break if sufficient force is directed towards it. Type 5 is a type 4 with fracture of medial condyle. The humeral head is covered in articular cartilage and articulates. Its upper surface is rounded and marked by three flat impressions. Download rehabilitation guidelines for proximal humerus fracture orif book pdf free download link or read online here in pdf.
Fractures of the proximal humerus are common, accounting for 5% of all fractures. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. A proximal humerus fracture is a crack or break in the top of your upper arm bone. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Fashion removable longarm splint holding the elbow in 90 degrees. Most of these fractures are treated with a collar and cuff sling followed by physiotherapy. Proximal humerus fracture east sussex healthcare nhs trust. Fractures of this region are common both with highenergy. Extension and internal rotation not performed until 6 weeks 4. 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.
Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2. He subdivided the proximal humerus into four major areas. Proximal humerus fracture reverse shoulder arthroplasty. There may be a decreased ability to move the arm and the person may present holding their elbow. Proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery. Twentyseven patients were treated operatively for proximal humeral fracture using the polarus nail. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. 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. All books are in clear copy here, and all files are secure so dont worry about it. With fl exion, the radius is in contact with the radial fossa of the distal humerus, whereas in extension, the radius and the humerus are not in contact. Proximal humerus fractures phfs are common, particularly among older. It is the third most common fracture that occurs in.
Proximal humerus fractures the hospital for sick children. Proximal humerus fractures what is a proximal humerus fracture. The shoulder is a ball and socket joint and you have fractured the ball part. What is typical recovery time for a proximal humerus fracture. 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. Internal fixation of proximal humeral fractures using the. Proximal humerus bone fractures overview verywell health.
Austin crow md altoona office chippewa falls office 1200 oakleaf way, suite a altoona, wi 54720 tel. A balance of fracture healing, patient pain, and prevention of loss of range of motion is the foundation of patient outcomes. Nonoperative proximal humeral fracture rehabilitation. 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 of motion, strength, and optimize activities of daily living.
Post fracture proximal humerus rehabilitation guidelines. My 89 year old mother fell and has a distal, supracondylar fracture of the humerus. Distal humerus fracture open reduction and internal fixation. The shoulder joint is essentially a ball and socket joint. Type 5 is a type 4 with fracture of medial condyle osteoporoticbone can be associated with undisplaced supercondylar fx. Bony healing occurs usually within 6 to 8 weeks in adults 3. In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone after hip fractures and wrist fractures. The sports physical therapy service is an integral part of the sports medicine center and the department of. 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. The crux of this system is based around the bony anatomy of the proximal humerus defined by codman in the 1930s.
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. Olecranon fracture orif early motion therapy protocol. Find pdfs of our most common rehabilitation protocols. This will help provide pain relief and allow the fracture to. 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. At this clinic decisions will be made regarding further imaging, such as xrays, and follow up. Electrotherapy or hydrotherapy does not enhance recovery. Proximal means it is the end of the bone that is closest to the body.
Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. Mathes proximal upper humerus arm bone fractures breaks are common injuries.
Functional outcomes for surgically treated 3 and 4part. A patients guide to adult proximal humerus shoulder fractures ciansurgeon will be specific about the type of fracture you have incurred. 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. The blood supply to the proximal humerus is a little unique, and thats where the treatment options vary. Increasing degrees of displacement and instability, as seen in conservatively managed neer three and fourpart fracture configurations, are associated with. Patient education proximal humerus fractures the core institute. This information will guide you through the next 6 weeks of your rehabilitation. Anuj punnoose msc mcsp physiotherapy lead and clinical. Return to normal function and motion may require 3 to 4 months overall goals. This paper outlines the indications, introduces various fracture prostheses, describes the surgical technique, and rehabilitation for treatment of proximal humerus fractures with a fracture prosthesis hemiarthroplasty.
The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Indications for promos standard system include advanced degeneration of the shoulder joint as a result of degenerative, posttraumatic or inflammatory arthritis avascular necrosis of the humeral head complex fractures of the proximal humerus.
P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial. Read online rehabilitation guidelines for proximal humerus fracture orif book pdf free download link book now. There are three main contributions to the vascular supply of the humeral head. In younger patients, highenergy trauma is the cause of injury.
Rehabilitation is central to addressing the problems caused by the fracture. Nonoperative management of proximal humerus fractures. A proximal humerus fracture occurs near the shoulder and is most common in older adults with osteoporosis. Victoria bc v8z 0b9 tel 250 940 4444 fax 250 385 9600 page 1 april 2015 v1s. Klein, md kennedy white orthopaedic center what is a proximal humerus fracture. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms.
Rehabilitation after proximal humeral fractures request pdf. The most useful rehabilitation protocol is the threephase system. 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. You have broken the top of your arm bone near your shoulder joint proximal humerus.