Condition

Shoulder fractures

Proximal humerus fractures — breaks of the upper arm bone near the shoulder joint — are serious injuries that most commonly result from falls, particularly in older adults with osteoporosis. Treatment ranges from immobilization for minimally displaced fractures to surgical fixation or joint replacement for complex, displaced, or comminuted patterns.

Common Symptoms

1 Severe pain and swelling immediately after injury
2 Inability to move the arm normally
3 Visible deformity or abnormal contour of the shoulder
4 Extensive bruising that may extend down the arm
5 Numbness or tingling in the hand or fingers

Overview

What Are Shoulder Fractures?

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.

Dr. Jay Levin at Duke Health in Durham, NC, specializes in the surgical and nonsurgical management of shoulder fractures, serving patients from Cary, Raleigh, Chapel Hill, and throughout North Carolina.

Treatment Options at Duke Health

Nonsurgical treatment is appropriate for minimally or nondisplaced proximal humerus fractures, treated with a sling and progressive physical therapy.

Surgical treatment is required for displaced or complex fractures. Dr. Levin performs open reduction and internal fixation (ORIF) with plates and screws, proximal humerus hemiarthroplasty, and reverse total shoulder replacement for elderly patients with highly comminuted fractures and rotator cuff deficiency.

Frequently Asked Questions

Do all shoulder fractures require surgery?
No. Many proximal humerus fractures — particularly those that are minimally displaced — can be treated successfully with a sling, pain management, and early physical therapy. Surgery is considered when the fracture is significantly displaced, involves multiple fragments, or when the blood supply to the humeral head is at risk. Dr. Levin at Duke Health in Durham uses X-ray and CT imaging to classify each fracture and determine the safest and most effective treatment.
What is the difference between fracture fixation and shoulder replacement for a broken shoulder?
Fracture fixation (ORIF — open reduction and internal fixation) uses plates and screws to realign and hold the bone fragments in place while they heal. Shoulder replacement removes the damaged bone and replaces it with an implant. For younger patients and certain fracture patterns, fixation preserves the native joint. For elderly patients with highly comminuted fractures or compromised blood supply to the humeral head, a reverse shoulder replacement often provides more reliable pain relief and faster functional recovery.
How long does it take to recover from a proximal humerus fracture?
Healing of the bone typically takes 6–12 weeks, but functional recovery is a longer process. Patients are usually in a sling for 4–6 weeks, followed by physical therapy to restore range of motion and strength. Full recovery, including return to lifting and overhead activity, commonly takes 4–12 months depending on fracture severity and treatment approach.

Not Sure What's Causing Your Pain?

Schedule an evaluation with Dr. Levin.

Request an Evaluation Call 919-613-7797