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# Proximal humerus fracture

A proximal [humerus](https://durgical.com/en/anatomy/humerus/) fracture is a break of the top of the upper arm bone, near the shoulder; it is a typical fracture of older adults with fragile bones.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Humerus](https://durgical.com/en/anatomy/humerus/)
- [Humeral head cartilage](https://durgical.com/en/anatomy/articular-cartilage-of-the-humeral-head/)
- [Axillary nerve](https://durgical.com/en/anatomy/axillary-nerve/)
- [Circumflex humeral arteries](https://durgical.com/en/anatomy/anterior-and-posterior-circumflex-humeral-arteries/)
- [Supraspinatus](https://durgical.com/en/anatomy/supraspinatus/)
- [Subscapularis](https://durgical.com/en/anatomy/subscapularis/)
- [Axillary artery](https://durgical.com/en/anatomy/axillary-artery/)
- [Middle deltoid](https://durgical.com/en/anatomy/deltoid-middle-part/)

## Why it happens

- [Bone remodeling](https://durgical.com/en/physiology/bone-remodeling/)
- [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/)

## What it is

A break of the upper end of the humerus: the head, the anatomical or surgical neck, or the greater and lesser tuberosities. It is a typical fragility fracture of older adults.

## Who gets it

Very common in older people, especially women with osteoporosis, and rising as the population ages in Colombia and Latin America. In young people it follows high-energy trauma.

## Causes

- Fall from standing height onto an outstretched hand or the side of the shoulder
- High-energy trauma (traffic accidents, falls from height) in younger patients
- Fracture-dislocation with a shoulder dislocation; rarely seizures or electric shock

## Risk factors

- Older age and female sex
- Osteoporosis
- Frequent falls, poor balance or vision
- Previous fragility fracture
- Long-term corticosteroid use

## Pathophysiology

Weak metaphyseal bone fails at the surgical neck, where fractures are most common. The rotator cuff and [pectoralis major](https://durgical.com/en/anatomy/pectoralis-major-muscle/) pull the fragments in set directions: the [supraspinatus](https://durgical.com/en/anatomy/supraspinatus/) pulls the greater tuberosity up and back, the [subscapularis](https://durgical.com/en/anatomy/subscapularis/) pulls the lesser tuberosity inward. Damage to the [circumflex humeral arteries](https://durgical.com/en/anatomy/anterior-and-posterior-circumflex-humeral-arteries/) can cut the blood supply of the head and lead to avascular necrosis.

## Classification

- Neer: counts the four parts (head, greater tuberosity, lesser tuberosity, shaft); a part counts as displaced when separated or angulated beyond widely taught thresholds
- One-part (non-displaced), two-, three- and four-part fractures
- Fracture-dislocations and head-splitting fractures
- AO/OTA classification is also used

## Symptoms and signs

- Shoulder pain after a fall
- Arm held against the body, unable to lift it
- Swelling and extensive bruising that spreads down the arm and [chest](https://durgical.com/en/anatomy/region/chest/) over days
- Crepitus with movement

## Red flags

- Numb patch over the lateral shoulder or weak deltoid (axillary nerve injury)
- Cold, pale hand or weak radial pulse ([axillary artery](https://durgical.com/en/anatomy/axillary-artery/) injury)
- Associated dislocation of the humeral head
- Open fracture or [skin](https://durgical.com/en/anatomy/skin/) under tension

## Diagnosis

**Clinical**
Bruising and tenderness over the proximal arm. Clinicians test sensation over the lateral deltoid (regimental badge area) and deltoid contraction for the [axillary nerve](https://durgical.com/en/anatomy/axillary-nerve/), plus distal pulses.

**Tests**
Preoperative blood tests as needed; workup for osteoporosis (calcium, vitamin D) after a fragility fracture.

**Imaging**
Shoulder trauma X-ray series including an axillary or scapular Y view to rule out dislocation. CT helps plan surgery in three- and four-part fractures.

## Differential diagnosis

- Shoulder dislocation
- Rotator cuff tear
- [Clavicle](https://durgical.com/en/anatomy/clavicle/) fracture
- Acromioclavicular joint separation
- Pathological fracture through a bone metastasis

## Goal of treatment

Achieve a painless, functional shoulder, protect the blood supply of the humeral head and avoid long immobilisation in frail patients.

## Treatment

**Conservative**
Most fractures, especially minimally displaced ones, are treated in a sling with early gentle pendulum exercises once pain allows.

**Surgical**
Displaced fractures in active patients may need fixation with a locking plate or intramedullary nail; complex fractures in older adults may get a shoulder replacement (hemiarthroplasty or reverse arthroplasty).

**Rehabilitation**
Physiotherapy progresses from passive to active motion and strengthening to limit stiffness.

**Medical**
Analgesics for pain, and osteoporosis treatment (such as bisphosphonates with calcium and vitamin D) to prevent the next fracture.

## Complications

- Shoulder stiffness
- Avascular necrosis of the humeral head
- Malunion or non-union
- Axillary nerve or artery injury
- Fixation failure or screw cut-out in osteoporotic bone

## Prognosis

Most minimally displaced fractures heal with a functional shoulder, though some stiffness is common. Results of complex fractures in older people vary, and evidence on surgery versus sling treatment is still debated.

## Prevention

- Fall prevention at home
- Diagnosis and treatment of osteoporosis
- Exercise for strength and balance

## Test yourself

Think of the answer, then tap the question to see it.

## Which nerve is most at risk in a proximal humerus fracture, and how is it tested?

The axillary nerve, which winds around the surgical neck. Clinicians test sensation over the lateral shoulder and deltoid contraction.

## What are the four parts of the Neer classification?

The humeral head (articular segment), the greater tuberosity, the lesser tuberosity and the humeral shaft.

## Which X-ray view is essential to rule out an associated shoulder dislocation?

An axillary view or a scapular Y view, added to the anteroposterior view.

## Why can four-part proximal humerus fractures lead to avascular necrosis?

The fracture can disrupt the circumflex humeral arteries that supply the humeral head.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/proximal-humerus-fracture/)

## Related conditions

- [Osteoporosis](https://durgical.com/en/conditions/osteoporosis/)
- [Shoulder dislocation](https://durgical.com/en/conditions/shoulder-dislocation/)
- [Rotator cuff tear](https://durgical.com/en/conditions/rotator-cuff-tear/)
- [Frozen shoulder (adhesive capsulitis)](https://durgical.com/en/conditions/frozen-shoulder/)
- [Humeral shaft fracture](https://durgical.com/en/conditions/humeral-shaft-fracture/)
- [Axillary nerve injury](https://durgical.com/en/conditions/axillary-nerve-injury/)
- [Acromioclavicular joint separation](https://durgical.com/en/conditions/acromioclavicular-joint-separation/)
- [Clavicle fracture](https://durgical.com/en/conditions/clavicle-fracture/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Proximal Humerus Fracture](https://www.ncbi.nlm.nih.gov/books/NBK470346/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/proximal-humerus-fracture/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/proximal-humerus-fracture/