Proximal humerus fractures are common shoulder injuries that involve the upper part of the arm bone (humerus) near the shoulder joint. Pproximal humerus fractures are commonly seen among elderly people , this is tne 3rdost common fracture in the body These fractures are classified categorized based on the number of broken parts and their alignment: two-part, three-part, or four-part fractures. The parts refer to specific sections of the bone that may break or displace, including the humeral head (the ball), the greater and lesser tuberosities (where muscles attach), and the humeral shaft (the long arm bone portion).
two-part fracture, only one section is displaced or broken. Three-part fractures involve two dislocated sections, while four-part fractures have breaks in all major sections, causing significant instability and misalignment of the shoulder joint.
For non-displaced or minimally angulated fractures, non-surgical management is often effective. Treatment usually includes immobilization with a sling, followed by physical therapy to restore shoulder movement and strength as the bone heals. However, surgery becomes necessary for fractures where the bone parts are displaced, especially in cases where alignment or function could be compromised.
Four-part fractures, particularly in older adults with poor bone quality (such as osteoporosis), are challenging to treat due to the high risk of complications and limited healing potential. In such cases, reverse shoulder replacement surgery is often recommended. This procedure replaces the shoulder joint with a prosthetic implant, reversing the ball-and-socket configuration to optimize stability and movement. This approach provides better outcomes for elderly patients, helping them regain shoulder function and reducing pain.
