Most proximal humerus fractures are undisplaced - one-part fractures - and may be treated conservatively. The arm should be supported in a sling for about 4 weeks until pain subsides. The hand should be actively exercised throughout. Initially, the shoulder is immobile; after 4 weeks, it should be moved passively; and after 6 weeks, actively.
Usually, two-part fractures can be reduced without operation and then supported with a chest bandage for 4 weeks. A humeral neck fracture however, may require internal fixation to avoid the risk of avascular necrosis of the humeral head.
Three-part and four-part fractures are progressively, less stable. Most require open reduction and internal fixation. External fixation however, may successfully treat three-part fractures whereas prosthetic replacement of the proximal humerus may be indicated in a four-part fracture.
Separation of the proximal epiphysis in children is best treated conservatively, with rest in a sling for about 3 weeks.
Last reviewed 01/2018