Proximal Humerus Fracture in Older Adults: Treatments and Recovery Times Explained

Let me briefly explain what the humerus is - it's the longest bone in the arm, connecting the shoulder joint to the elbow. Several muscles intersect here, including the biceps, triceps, and deltoid.

Did you fall on your outstretched arm and fracture your humerus?

Proximal humerus fractures are the third most common fractures, with about 75% occurring in adults over 65 with osteoporotic bone after a fall. A humerus fracture can be painful and significantly limit arm mobility.

Besides age and osteoporosis, other risk factors include vitamin D deficiency, history of previous falls, or prolonged use of certain medications like corticosteroids that can cause degenerative changes in joints, making them stiffer and weaker.

Additionally, joints can undergo degenerative changes that reduce flexibility and increase stiffness, promoting joint problems and making falls more likely.

How does proximal humerus fracture occur?

When falling, it's almost instinctive to extend or 'put out' your arms, which can cause this fracture. Falls don't necessarily need to be dramatic or high-impact to injure and fracture the humerus; with age and bone loss, one becomes more prone.

Age, bone health, nutrition, and complexity of the fall play a determining role in choosing a specific treatment. Often patients present with osteoporosis, significant wear, or diabetes which can place them in a vulnerable situation during the fracture healing process.

Types of humerus fractures according to Neer classification

The Neer classification divides proximal humerus fractures into four types, according to their complexity:

• Non-displaced fracture: The bone breaks but the parts remain in place.
• Two-part fracture: One fragment of the bone moves, usually in the area of the humeral neck or the tuberosities (protruding parts of the bone).
• Three-part fracture: Two bone fragments are displaced, which can cause shoulder deformity.
• Four-part fracture: The most severe, as all parts of the bone are displaced, increasing the risk of complications such as lack of circulation in the affected area.

Conservative and surgical treatment

Treatment will depend on the type of fracture. For minimally displaced fractures, immobilization is recommended. In more complex fractures, surgery may be necessary, such as osteosynthesis with plates and screws, the use of intramedullary nails, or in more severe cases, a shoulder arthroplasty.

What is daily life like with conservative treatment?

During the first week, pain and discomfort are inevitable. It's essential to maintain relative rest but ensuring movement of the hand, fingers, wrist and elbow to reduce inflammation and prevent stiffness.

Recovery phases

• Pain control
• Learning movements for daily activities (dressing, grooming, sleeping with immobilization).
• Passive movements and periscapular exercises
• Active mobilization of wrist and fingers
• Isometric and isotonic exercises to maintain strength
• Phase II (2-6 weeks):
• If there's no risk of displacement, immobilization use can be reduced and mobility exercises begun.
• Phase III (6-12 weeks):
• Aim to recover maximum active range of motion
• Strengthening shoulder muscles
• Gradual return to daily and sports activities
• Phase IV (3-6 months):
• Maximize strength and joint range with physiotherapy
• Gradual incorporation of sports like swimming. Contact sports like basketball or soccer will depend on the degree of bone consolidation.

Prevention of humerus fractures in older adults

Habits

• Maintain a diet rich in calcium and vitamin D
• Perform bone strengthening and balance exercises
• Attend an evaluation consultation with a specialist - it's not necessary to wait for pain, this is about prevention that allows knowing about the patient's bone density and quality and whether they require supplements to improve their bone and joint health.

Spaces

The vast majority of falls and bone fractures occur at home, which is where the main preventive measures should be taken:

• Remove rugs to avoid tripping on edges
• Adapt bathrooms, showers
• Relocate objects in high areas so you don't need to use a stool or something that could slip and cause a fall.
• If there are stairs, go up and down holding onto the handrail, illuminate them properly and ensure proper foot support on each step.

Recommended home exercises for humerus rehabilitation

Below I share three simple exercises you can do at home to improve your shoulder mobility after immobilization. It's important to do 10 repetitions of each and complement them with your physiotherapist's rehabilitation protocol.

Pendulum exercises: Stand next to a table, lean on it with your healthy hand, bend forward and make movements forward and backward and side to side in both directions.

Elevation: Stand facing a wall and crawl your fingers upward as high as possible. Slowly descend to the starting position.

Posterior stretches: Pass the hand of the affected arm over the opposite shoulder, placing the hand of the healthy arm on the elbow. Use the healthy arm to help try to touch your chin.

When can I return to sports after a humerus fracture?

Low-impact sports like swimming can be resumed after the third month, while contact sports will depend on bone consolidation and your specialist doctor's recommendation.

Receiving specialized medical attention immediately is key for a proximal humerus fracture. However, recovery success doesn't just depend on initial treatment, but also on collaboration with physiotherapists and rehabilitation specialists.

A personalized recovery plan is essential to ensure restoration of mobility and independence. Although the process can be challenging, the goal is clear: Regain functionality and live a pain-free life.