Proximal Humerus Fractures
A proximal humerus fracture is a break near the shoulder joint.
Understanding the injury
The proximal humerus includes the humeral head, greater and lesser tuberosities, and the upper shaft. Fractures can involve one or several of these regions. The tuberosities are particularly important because the rotator cuff tendons attach to them. A fracture-dislocation may also injure cartilage, nerves, blood vessels, and the blood supply to the humeral head. The number of fragments alone does not determine treatment. Their displacement, rotation, stability, soft-tissue attachments, and ability to support fixation are more important.
Evaluation
The examination assesses skin condition, swelling, shoulder alignment, sensation, motor function, and circulation. X-rays define the basic fracture pattern. CT imaging may clarify the joint surface, tuberosity position, head-split components, dislocation, and the feasibility of fixation. Medical health and preinjury function matter. The same fracture may be treated differently in a frail patient who prioritizes independence and an active patient who needs high-level shoulder use.
Nonsurgical care
Nonsurgical treatment may be appropriate when alignment is acceptable, the joint is stable, and expected function is reasonable. The shoulder is protected in a sling, while hand, wrist, and elbow motion begins early. Shoulder motion is introduced according to pain, stability, and healing. Follow-up X-rays are important because some fractures shift after the initial visit. Prolonged immobilization can contribute to stiffness, so rehabilitation must balance protection with timely motion.
Surgical fixation or replacement
Open reduction and internal fixation can preserve the native joint when the fragments can be reconstructed and held securely. Plates, screws, sutures, and selected bone-support strategies may be used. Success depends on fracture anatomy, blood supply, bone quality, fixation, and rehabilitation. Reverse shoulder replacement may be considered when a complex fracture cannot be reconstructed reliably, especially when bone quality is limited or the joint and rotator cuff attachments are severely disrupted. The tuberosities may still be repaired around the implant because their healing can improve rotation. Hemiarthroplasty has a more selective role.
Patient Experience
“Dr. Knudsen and his team were incredibly helpful with my shoulder fracture, rotator cuff tear, and biceps tear. Despite the complexity of my injury, his surgery was successful, and I was playing tennis again six months after my injury.”
Patient following complex traumatic shoulder surgery | Google review
These testimonials describe individual patient experiences. Treatment recommendations, recovery, and outcomes vary by patient.
Recovery and urgent symptoms
Recovery commonly continues for many months and may continue for a year or longer. Some stiffness, weakness, or loss of motion can persist despite appropriate treatment. Urgent evaluation is needed for an open wound, skin threatened by a fragment, a cool or pale hand, new numbness or inability to move the fingers, severe deformity, fracture-dislocation, rapidly increasing pain, or uncontrolled swelling.
This information is educational and is not a substitute for an individualized medical evaluation. Written and medically reviewed by Michael L. Knudsen, MD | Last reviewed: July 2026
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