Proximal humerus fractures

1. How much must a portion of the humerus be displaced to call it a fragment?
2. What is the most common location of humerus fractures? What are other locations?
3. What are the symptoms of proximal humerus fracture?
4. What are the surgical and non-surgical treatments?
5. What are complications of proximal humerus fracture? What nerve is often involved in surgical neck fractures?

Answers:
1. Angulated by 45 degrees or displaced >1cm.
2. Most common is the surgical neck, followed by the greater tuberosity, lesser tuberosity, and anatomical neck.
3. This fracture is common in osteoporotic elderly women after a fall and involves pain, swelling, and ecchymosis. Loss of sensation or diminished radial pulse may occur. If there's a fracture of the surgical neck, the supraspinatus causes abudction of the proximal fragment of the humerus.
4. Conservative treatment is early ROM, sling immobilization, rehab, pendulum exercises. If displaced, need ORIF.
5. Complications include brachial plexus injury, axillary artery compromise, and avascular necrosis of the humeral head. The axillary nerve is involved in surgical neck fractures.