Understanding your injury

A proximal humerus fracture affects the upper arm bone near its ball at the shoulder. A fall is a common cause; weakened bone can increase the risk. Pain, bruising and swelling may extend down the arm. Assessment checks the skin, nerves, circulation and associated injuries. X-rays define the fracture, with CT used for selected complex patterns. A fracture can sometimes occur with a shoulder dislocation.

Treatment and the procedure

Many proximal humerus fractures heal without surgery, using a sling, pain relief and planned rehabilitation. NICE recommends nonoperative treatment for uncomplicated displaced low-energy fractures in adults. Complicated injuries, including an open wound, threatened skin, vessel injury, fracture-dislocation or a split humeral head, may require surgery. Options can include fixation with plates and screws or shoulder replacement. The choice considers fracture anatomy, bone quality, general health and realistic functional goals.

Benefits, risks and expectations

If surgery is planned, discuss bleeding, anaesthetic risks and complex regional pain syndrome as well as the risks specific to your injury. Your general health and the extent of surgery affect your personal risk.

Treatment aims to reduce pain and restore useful shoulder function. Recovery of movement may continue well beyond initial bone healing; full movement is not guaranteed.
Discuss stiffness, persistent pain, poor healing or altered alignment, and damage to the humeral head's blood supply. Further treatment may be needed.
Surgery adds risks such as infection, nerve injury and fixation or implant problems. Replacement has specific risks, including instability and restrictions that depend on the implant and soft-tissue repair.

Rehabilitation and aftercare

Use the sling and begin shoulder movement only as directed for your fracture or operation. Keep the elbow, wrist and fingers moving within your instructions. Physiotherapy introduces supported movement, active use and strengthening in stages. Avoid lifting or supporting your body weight through the arm until cleared. Arrange help with dressing, bathing and food preparation if needed. Discuss bone health after a fragility fracture and obtain individual advice about driving and work.

When to get urgent help

A cold, discoloured or increasingly numb hand, severe worsening pain, an open wound or skin stretched over a fragment needs urgent assessment. Report fever or wound discharge promptly.
Call 999 for chest pain or severe breathlessness.

Your consultation

Ask why surgery or nonoperative treatment is preferred, when movement can begin and what overhead function is realistic. Your personal consent discussion and written rehabilitation plan govern treatment.

Your consent discussion

Use the patient pack to record your priorities, the proposed procedure, its alternatives, the benefits you hope for and risks that matter to you. A clinician will discuss your individual circumstances and complete the appropriate hospital consent process with you.

Reading or downloading a guide does not give consent. You can ask further questions, decline treatment or change your mind before the procedure.

Proximal humerus and shoulder fractures