Proximal humerus fracture in Adult
Alerts and Notices
Synopsis
Causes / typical injury mechanism: Proximal humerus fractures most commonly occur in the elderly population, typically from ground level falls in the setting of osteoporosis or osteopenia. However, these fractures can also occur in younger patients from high-energy impacts.Classic history and presentation: An elderly patient presenting with arm pain after a ground level fall on an outstretched arm in an attempt to brace themselves.
Prevalence: Accounts for 5%-6% of all adult fractures.
- Age – most common in patients older than 65 years
- Sex / gender – 2:1 female-to-male ratio
Pathophysiology: Osseous components of the proximal humerus become fractured or displaced, usually secondary to direct trauma. Traditionally, proximal humerus fractures have been classified by their component fractured parts: humeral shaft, humeral head, greater tuberosity, and lesser tuberosity.
Grade / classification system:
Neer Classification
In order to be classified as a fractured part, the fractured component needs to either be displaced greater than 1 cm or have angulation exceeding 45 degrees. The exception is the greater tuberosity, which is considered displaced at 5 mm.
- One-Part Fracture
- Fracture involves 1-4 parts
- No parts are displaced
- Two-Part Fracture
- Fracture involves 2-4 parts
- One part is displaced
- Three-Part Fracture
- Fracture involves 3-4 parts
- Two parts are displaced
- Four-Part Fracture
- Fracture involves more than 4 parts
- Three parts are displaced
Codes
ICD10CM:S42.209A – Unspecified fracture of upper end of unspecified humerus, initial encounter for closed fracture
SNOMEDCT:
127286005 – Fracture of upper end of humerus
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Clavicle fracture
- Humeral shaft fracture
- Rotator cuff tear
- Shoulder dislocation
- Shoulder impingement syndrome
- Proximal biceps subluxation (see proximal biceps tendonitis)
- Acromioclavicular joint separation
- Lesser tuberosity avulsion fracture
- Greater tuberosity avulsion fracture
- Pathologic fracture of the proximal humerus
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
References
Subscription Required
Last Reviewed:09/26/2022
Last Updated:11/01/2022
Last Updated:11/01/2022
Proximal humerus fracture in Adult