Synopsis
Recognise proximal humeral fracture and its axillary-nerve, vascular and dislocation associations, distinguish stable patterns from reconstructive emergencies, and preserve function through safe analgesia and rehabilitation.
- Most proximal humeral fractures in older adults follow a fragility fall and can be treated without surgery when closed, aligned and neurovascularly safe.
- Inspect bruising, swelling, wounds and skin pressure and examine clavicle, scapula, elbow and wrist for associated injury.
- Test deltoid contraction and lateral-arm sensation plus distal radial, median and ulnar functions and pulses before and after support or manipulation.
Key red flags
A cool hand, pulse change, expanding axillary swelling or multi-nerve deficit suggests axillary artery or brachial-plexus injury.
Marked deformity, locked motion and abnormal head position on orthogonal imaging requires urgent specialist reduction planning.
Investigation priorities
Define fragments, displacement, tuberosities and glenohumeral congruence.
Management branches
A patient has shoulder pain and bruising after trauma.
- Use ABCDE for high energy and inspect wounds, skin and associated shoulder-girdle injury.
- Provide analgesia and support and record axillary, distal nerve and vascular findings.
The closed fracture is acceptably aligned with a congruent joint and intact limb.
Key medicines
Paracetamol for adult fracture painGive 500 mg to 1 g orally when required up to four times daily, at least 4 hours apart and no more than 4 g in 24 hours.