Personalized treatment for broken shoulders and upper-arm fractures near the shoulder, including sling treatment, early rehabilitation, ORIF and shoulder replacement.
A proximal humerus fracture is a break in the upper portion of the arm bone where it forms the ball of the shoulder joint.
The fracture can involve the humeral head, surgical neck, greater tuberosity or lesser tuberosity. The rotator cuff attaches to the tuberosities, so their position can have a major effect on shoulder strength and motion.
Some fractures are small cracks or impacted injuries that remain well aligned. Others are displaced into several parts, associated with a shoulder dislocation or too fragmented to reconstruct predictably.
Go to the emergency room for an open wound over the fracture, severe deformity threatening the skin, a cold or pale hand, loss of a pulse, rapidly worsening numbness or weakness, an unreduced shoulder dislocation or major trauma with additional injuries.
Two patients with similar-looking fractures may reasonably choose different treatments.
The best plan depends on whether the shoulder can heal in a useful position and whether an operation is likely to provide a meaningful advantage for that specific patient.
Proximal humerus fractures are one of the clearest examples in orthopedics where several options may be medically reasonable. For some displaced fractures, nonoperative care and surgery can produce similar overall outcomes. In other cases, two different operations may offer different trade-offs without one being clearly superior for every patient.
Our job is not to force every fracture into the same treatment. It is to explain what each option can realistically accomplish, what it cannot guarantee and which risks matter most to the individual patient.
A simple sling followed by gentle, appropriately timed rehabilitation is often a very reasonable treatment.
The sling supports the arm and helps control pain during the early phase. The hand, wrist and elbow should usually continue moving unless another injury prevents it.
Gentle shoulder motion is introduced as pain and fracture stability allow. Immobilizing the shoulder for too long can create severe stiffness, but moving too aggressively too early can displace the fracture. The rehabilitation plan must balance both risks.
Repeat X-rays help confirm that alignment is maintained while healing begins.
The main surgical choices are fracture fixation, selected anatomic replacement options and reverse shoulder replacement.
ORIF restores the position of the humeral head and tuberosities and secures the fracture with a plate, screws and strong sutures through the rotator cuff.
Fixation is generally more attractive in younger patients, patients with stronger bone and fractures that can be reconstructed reliably. It preserves the patient’s natural shoulder but depends on healing, blood supply and stable fixation.
Traditional replacement options may be considered in selected fractures when the humeral head cannot be saved but the rotator cuff and tuberosities can be reconstructed.
Results depend heavily on tuberosity healing and rotator cuff function, so this is not the best choice for every complex fracture.
A reverse shoulder replacement changes the mechanics of the joint so the deltoid can help raise the arm even when the rotator cuff or tuberosities cannot function normally.
It has become a workhorse for severe three-part, four-part, fracture-dislocation and head-splitting injuries that cannot be repaired predictably.
Even some displaced fractures can be treated without surgery, particularly when the patient accepts some loss of motion or when surgery is unlikely to improve function enough to justify its risks.
Nonoperative treatment is not “doing nothing.” It requires protection, follow-up imaging, progressive rehabilitation and realistic expectations.
Age remains important, but it is not the only factor.
Older patients are more likely to have weaker bone, severe comminution and tuberosities that may not heal predictably after fixation. Reverse replacement can provide a more dependable path to useful shoulder elevation when reconstruction is unlikely to succeed.
In a younger or more active patient, preserving the natural shoulder with ORIF is generally desirable when the fracture can be reconstructed. However, reverse replacement is increasingly considered when the humeral head is split, the bone is not reconstructible, blood supply is severely compromised or fixation would be unlikely to survive.
The durability of an implant and the patient’s lifetime activity demands must be part of that discussion.
A surgeon who offers only one operation may naturally view every complex fracture through that single lens.
Our surgeons perform proximal humerus ORIF, traditional/anatomic shoulder replacement options and reverse shoulder replacement. We also treat many fractures without surgery.
Because we are comfortable with each approach, the recommendation can be based on the patient rather than on the limitations of the surgeon’s procedure list.
The goal is useful, comfortable function—not simply a better-looking X-ray.
Use the sling as directed, control swelling and maintain hand, wrist and elbow motion.
Gentle shoulder motion progresses according to fracture stability, fixation strength or the replacement procedure performed.
Strength, endurance and overhead use return more gradually and may continue improving for many months.
A patient who wants independent daily use of the arm may make a different choice than a patient whose work or sport requires heavy lifting or high-level overhead function. Dominant-arm injuries, preexisting rotator cuff disease, arthritis and prior shoulder function also affect what is realistically achievable.
Atlanta Bone and Joint Specialists provides nonoperative fracture care, ORIF and shoulder replacement for proximal humerus fractures.
Tell our scheduling team that you have a confirmed or suspected shoulder fracture. Bring your imaging disc, radiology reports, emergency-room paperwork and any prior shoulder records.
Call Atlanta Bone and Joint Specialists for an individualized discussion of sling treatment, ORIF, traditional replacement and reverse shoulder replacement.