features

Last reviewed 01/2018

Bruising and bleeding around the upper arm, rather than pain, tend to be the most conspicuous features. Pain may be less severe than expected since these fractures are often impacted. The bleeding may track down to the elbow with spectacular effect.

Four major segments may be involved:

• humeral head
• lesser tuberosity
• greater tuberosity
• surgical head of the humerus
• anatomical head of the humerus

The number of segments per se is less important than the number which are displaced. Neer's classification scheme is often used to guide subsequent management. It is based on the number of segments displaced - in a one-part fracture, no fragments are displaced irrespective of the number of fracture lines present; in a two-part fracture, one segment is separated from the others; two displaced segments defines a three-part fracture; and three, a four-part fracture.

The greater the number of segments displaced, the greater the risk of complications such as axillary nerve or brachial plexus injury.

In a separated upper humeral epiphysis injury in a child, the shaft shifts upwards and forwards, with the head remaining in the socket.

An axillary x-ray is necessary to exclude fracture dislocation.