What Are Shoulder and Elbow Fractures?
Fractures around the shoulder and elbow are among the most common orthopaedic injuries seen across all age groups, though the fracture patterns and optimal treatments differ significantly based on the patient's age, bone quality, and the specific anatomy involved.
Proximal humerus fractures — breaks of the upper arm bone near the shoulder joint — account for approximately 5–6% of all fractures and are the third most common fracture in adults over 65. They typically result from a fall onto an outstretched arm or directly onto the shoulder. These fractures range from simple two-part injuries with minimal displacement to complex four-part fractures in which the humeral head loses its blood supply and is at high risk of avascular necrosis.
Elbow fractures encompass a spectrum of injuries including distal humerus fractures, olecranon fractures (the bony point of the elbow), radial head and neck fractures, and coronoid fractures. Complex elbow injuries can involve multiple fractures combined with ligament tears, creating instability that requires precise surgical management.
Dr. Jay Levin at Duke Health in Durham, NC, specializes in the surgical and nonsurgical management of fractures around the shoulder and elbow, serving patients from Cary, Raleigh, Chapel Hill, and throughout North Carolina.
Causes
Shoulder and elbow fractures most commonly result from:
- Falls — the dominant mechanism across all ages; a fall onto an outstretched arm transmits significant force through the elbow or shoulder
- Motor vehicle accidents — high-energy trauma producing complex fracture patterns
- Direct impact — a blow to the shoulder or elbow in contact sports or workplace accidents
- Osteoporosis — low-energy falls that would not fracture a healthy bone can cause significant injuries in patients with weakened bones; this is why proximal humerus fractures are particularly prevalent in postmenopausal women
When to See a Specialist
Shoulder and elbow fractures are urgent injuries. Seek same-day or next-day evaluation if you experience:
- Immediate, severe pain and swelling following a fall or impact
- Inability to lift or move the arm
- Visible deformity or abnormal alignment
- Extensive bruising spreading down the arm within hours of injury
- Numbness, tingling, or weakness in the hand — signs that may indicate associated nerve or vascular injury
Any suspected fracture should be evaluated with X-rays. CT scanning is often needed for complex fractures to plan the optimal surgical approach. Nerve and vascular injuries, although uncommon, require prompt recognition and management.
Treatment Options at Duke Health
Dr. Jay Levin offers the full range of fracture management at Duke Health in Durham, NC, selecting the treatment that best balances reliable healing, early rehabilitation, and long-term function.
Nonsurgical treatment is appropriate for:
- Minimally or nondisplaced proximal humerus fractures, treated with a sling and progressive physical therapy
- Nondisplaced olecranon or radial head fractures with a full range of elbow motion
- Patients whose medical health makes surgery inadvisable
Surgical treatment is required for displaced or complex fractures. Dr. Levin performs:
- Open reduction and internal fixation (ORIF) — Fracture fragments are anatomically realigned and secured with plates, screws, or tension-band wiring. This allows early mobilization while the bone heals and is preferred for younger patients and fractures with a good vascular supply to the humeral head.
- Proximal humerus hemiarthroplasty — The humeral head is replaced with a metal implant when it cannot be reliably fixed or when its blood supply is compromised. Used selectively in specific fracture patterns.
- Reverse total shoulder replacement — For elderly patients with highly comminuted proximal humerus fractures and rotator cuff deficiency, a reverse replacement often provides the most predictable pain relief and functional outcome, with faster rehabilitation than complex fixation.
- Elbow fracture fixation and reconstruction — Distal humerus fractures, olecranon fractures, and radial head fractures are repaired with specialized implants designed to restore elbow stability and allow early range-of-motion exercises.
- Total elbow arthroplasty — In elderly patients with severely comminuted distal humerus fractures, replacing the elbow joint may provide better outcomes than attempting complex fixation of poor-quality bone.
Following fracture surgery, early supervised physical therapy is critical to prevent stiffness — particularly around the elbow, which is notoriously sensitive to immobilization — while protecting the healing bone and implants.