What are proximal humeral fractures?The upper part of the humerus bone forms the ball of the shoulder joint. It is relatively commonly injured following a fall onto an outstretched hand in older patients, while in younger patients it usually follows higher energy trauma. Often the fracture pieces are not significantly displaced, but ultimately treatment depends on the position of the joint surface and two important pieces of bone to which the rotator cuff tendons attach.
Proximal humeral fracture ORIF pre-op
What are the symptoms and signs?Sudden onset of pain in the shoulder following a fall; with a difficulty moving the arm secondary to this is common. Bruising and swelling, which may track down the arm is common, with patients often describing a “clicking” or “grinding” sensation with movement of the arm away from the body in the first few weeks following the injury. Ultimately, X-ray will confirm the diagnosis.
How is it treated?
- Non-surgical treatment
Many breaks can be treated non-surgically with pain relief and a sling for comfort for the first few weeks prior to commencing physiotherapy. In some cases, the displacement of the fragments of the bone may mean that your outcome and ultimate shoulder function may be limited if left untreated. In this situation we may recommend intervention with an operation to improve ultimate shoulder function.
- Surgical treatment
The two main surgical options are to fix the fracture using a specially designed plate and screws or to perform a particular type of reverse geometry shoulder replacement. The decision as to which of these is most appropriate is determined by many factors: patient age and number of fracture fragments are of paramount importance. Detailed information regarding reverse geometry total shoulder replacement can be found here.
What are the potential complications?With plate fixation of a proximal humeral fracture complications are rare, but include a risk of infection, damage to nearby nerves/blood vessels and delayed or non-healing of the break despite surgery. The specific risks associated with reverse geometry total shoulder replacement can be seen in the shoulder arthroplasty / replacement section.
What rehabilitation is necessary after surgery?A period of immobilisation in a sling is required, particularly until the wound has healed, and physiotherapy will be organised prior to discharge from hospital. Driving can often be resumed at around six-weeks, and return to contact sports considered 12 weeks following surgery.
Proximal humeral fracture ORIF post-op
Fracture reverse pre-op
Fracture reverse post-op
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.