A humeral head fracture is a break in the ball-shaped upper part of the humerus (arm bone) that connects to the shoulder joint. These fractures are common in older adults with osteoporosis and can vary in severity from minor cracks to complex breaks involving multiple pieces.

Causes of Humeral Head Fracture

1. Trauma
   • Direct impact or blow to the shoulder, often from a fall onto the outstretched arm or shoulder.
   • Common in motor vehicle accidents or high-impact sports injuries.
2. Falls
   • Falling onto an outstretched hand or directly onto the shoulder is a primary cause, especially in older adults.
3. Osteoporosis
   • Weak bones in elderly individuals increase the risk of fractures from minor trauma.
4. High-Energy Injuries
   • In younger individuals, fractures often occur from significant trauma, such as car accidents or falls from a height.
5. Pathological Fractures
   • Underlying conditions like bone tumors or bone infections can weaken the humeral head, leading to fractures.

Symptoms of Humeral Head Fracture

• Severe Shoulder Pain: Worsens with movement.
• Swelling and Bruising: Around the shoulder and upper arm.
• Deformity: The shoulder may appear misshapen or “flattened.”
• Restricted Movement: Difficulty or inability to move the arm.
• Crepitus: Grinding or cracking sensation during arm movement.
• Numbness or Tingling: May occur if nerves are compressed or injured.

Types of Humeral Head Fractures

According to the Neer classification, fractures are grouped based on the number of broken segments:

1. Non-displaced fractures: Bones remain in alignment.
2. Displaced fractures: Bone fragments are misaligned.
3. Comminuted fractures: The bone is broken into multiple pieces.
4. Fracture-dislocations: Associated with dislocation of the shoulder joint.

Treatment for Humeral Head Fracture

Non-Surgical Treatment

Most fractures (particularly non-displaced or minimally displaced fractures) are treated conservatively:

1. Immobilization
   • Use of a sling or shoulder immobilizer to keep the arm stable for 4–6 weeks.
   • Allows the bone to heal naturally.
2. Pain Management
   • Over-the-counter or prescribed pain medications (e.g., acetaminophen, NSAIDs).
   • Ice packs to reduce swelling.
3. Physical Therapy
   • Gradual range-of-motion exercises once initial healing occurs (usually after 2–4 weeks).
   • Strengthening exercises are introduced later to restore shoulder function.
4. Bone Health Optimization
   • For patients with osteoporosis, calcium and vitamin D supplements or medications like bisphosphonates may be recommended.

Surgical Treatment

Surgery is indicated for displaced, comminuted, or complex fractures, especially those involving significant joint instability.

1. Open Reduction and Internal Fixation (ORIF)
   • Realigning the bone fragments and stabilizing them with plates, screws, or pins.
2. Hemiarthroplasty
   • Replacement of the humeral head with a prosthesis, commonly performed for fractures with severe damage to the bone.
3. Reverse Total Shoulder Arthroplasty
   • Used in older patients or those with severe fractures and rotator cuff damage. Both the humeral head and socket are replaced.
4. Closed Reduction and Percutaneous Pinning
   • Minimally invasive procedure where pins are inserted to stabilize the fracture.

Recovery and Rehabilitation

1. Immobilization Phase: Initial healing occurs over 4–6 weeks; movement is limited to prevent re-injury.
2. Physical Therapy:
   • Focuses on restoring range of motion and strength.
   • May continue for 3–6 months, depending on the severity of the injury.
3. Gradual Return to Activities:
   • Full recovery may take 6–12 months for severe fractures.

Complications

• Stiffness or Frozen Shoulder: Due to prolonged immobilization.
• Malunion or Non-Union: Improper or incomplete healing of the fracture.
• Avascular Necrosis: Loss of blood supply to the humeral head, leading to bone death (common in severe fractures).
• Nerve or Blood Vessel Injury: Particularly involving the axillary nerve or brachial plexus.

Prevention

• Prevent falls by ensuring safe environments, especially for elderly individuals.
• Strengthen bones with adequate calcium, vitamin D, and regular weight-bearing exercises.
• Use protective gear during high-risk sports or activities.

If you suspect a humeral head fracture, seek medical attention promptly for diagnosis (X-rays or CT scans) and a tailored treatment plan. Early intervention can prevent complications and improve outcomes.