Proximal Humerus Fracture

Proximal humerus fractures are among the most common fractures in adults over 65 — the third most common fracture type in the elderly after hip and distal radius fractures. They typically occur from a fall onto an outstretched arm or directly onto the shoulder. The Neer classification describes fractures based on the number of displaced segments (1–4 parts): the humeral head, greater tuberosity, lesser tuberosity, and shaft.

The vast majority — over 80% — are minimally displaced and heal well with non-operative management. Displaced multi-part fractures, particularly in younger patients, are a complex reconstructive challenge.

Shoulder pain, swelling, and ecchymosis tracking down the arm and chest wall after a fall. Neurovascular assessment is critical — the axillary nerve is at risk. AP and scapular Y X-rays characterize most fractures. CT scan with 3D reconstruction guides surgical planning for displaced multi-part fractures. Axillary nerve and brachial plexus function must be documented.

Significantly displaced multi-part fractures in physiologically young, active patients and valgus-impacted four-part fractures in appropriate patients may benefit from surgery. The balance between fixation and replacement depends on fracture pattern, bone quality, and patient demands.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Shoulder (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language