A proximal humerus fracture — a break at the top of the arm bone — is one of the most common fractures in older adults, usually after a fall on an outstretched hand with osteoporosis. Most undisplaced fractures heal in a sling with physiotherapy, displaced fractures may need plates and screws, and for comminuted fractures in older patients reverse shoulder replacement is often the best option.
Types of fracture
- Undisplaced: the pieces stay roughly in place — the most common.
- Two-part displaced: usually through the neck of the bone.
- Three- or four-part: involving the head and the tuberosities where the rotator cuff attaches.
- Fracture-dislocation: needs urgent treatment.
Symptoms
- Severe shoulder pain after a fall.
- Swelling and bruising that can spread to the arm and chest over days.
- Inability to move the arm.
- Visible deformity with a dislocation.
Treatment options
| Option | Usually suits | Notes |
|---|---|---|
| Sling and physiotherapy | Undisplaced or minimally displaced fractures | The large majority of cases |
| Plate and screws | Displaced fractures with good bone | Preserves the natural joint |
| Hemiarthroplasty | Selected cases | Depends on tuberosity and tendon healing |
| Reverse shoulder replacement | Comminuted fractures in older adults with osteoporosis | Better function than hemiarthroplasty in a randomised trial |
Why a reverse replacement for complex fractures in older adults?
In comminuted fractures, small fragments in fragile bone are hard to fix, and the tuberosities may fail to heal so the rotator cuff stops working. A reverse replacement does not rely on those tendons, and a randomised trial found better functional results than hemiarthroplasty in older patients. The final decision depends on the fracture, bone quality and activity level.
Video: rotator cuff tears
Frequently asked questions about proximal humerus fractures
Does a proximal humerus fracture need surgery?
Most undisplaced fractures heal in a sling; displaced or comminuted fractures may need fixation or a joint replacement.
How long does it take to heal?
The bone usually heals in 6 to 8 weeks, but regaining motion and strength can take several months of physiotherapy.
When is a reverse replacement better than a plate?
In three- or four-part comminuted fractures in older adults with osteoporosis, where fixation is difficult and often fails.
Can I move my arm right after the fracture?
Hand and elbow exercises start early; shoulder movement depends on the treatment and your surgeon’s instructions.
What does osteoporosis have to do with it?
Osteoporosis lets the bone break from a minor fall and weakens fixation, so it should be assessed and treated after the fracture.
To have your shoulder assessed, book a consultation, call +20 155 240 4488 or message us on WhatsApp at +20 155 554 7181.
Medically reviewed by Prof. Dr. Ibrahim Shaarawi, Professor of Orthopaedic Surgery. This article is general medical education and does not replace an examination or the plan your surgeon sets for you. See our medical disclaimer.
Related shoulder replacement guides
Complex fractures are a major reason for reverse shoulder replacement. Read also:
- Reverse shoulder replacement
- Shoulder arthritis
- Rotator cuff tear arthropathy
- Recovery after reverse shoulder replacement
References
- Sebastiá-Forcada E, et al. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg. 2014;23(10):1419-26.
- American Academy of Orthopaedic Surgeons (OrthoInfo). Reverse Total Shoulder Replacement.
- Zumstein MA, et al. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg. 2011;20(1):146-57.