Lesson 1: Proximal Humerus Fractures

A. Pharmacological Management

1. Analgesics:

   • NSAIDs (e.g., ibuprofen 400 mg q8h) for mild–moderate pain.

   • Opioids (e.g., tramadol 50–100 mg q8h) for severe pain.

   • Avoid long-term opioids; use stepwise analgesic ladder (WHO).

2. Adjuncts:

   • Muscle relaxants (e.g., tizanidine, cyclobenzaprine).

   • Calcium and vitamin D supplementation in osteoporotic patients.

3. Antibiotics:

   • For open or surgical cases (e.g., IV cefazolin prophylaxis).

B. Conservative (Non-Operative) Management

Indications:

• Non-displaced or minimally displaced fractures (<1 cm, <45°).

• Elderly or low-demand patients.

Method:

1. Immobilization:

   • Sling and swathe, collar and cuff, or U-slab for 3–4 weeks.

2. Rehabilitation:

   • Pendulum exercises at 2–3 weeks.

   • Gradual passive → active-assisted → active motion at 4–6 weeks.

   • Strengthening phase after radiologic union (~8–12 weeks).

Follow-up:

• Radiographs every 2 weeks until healing confirmed.

C. Operative Management (Brief Overview)

Indications:

• Displaced fractures (>1 cm or >45°).

• Three- or four-part fractures.

• Head-splitting fractures.

• Associated dislocation.

• Open fractures or vascular/nerve compromise.

Post-op:

• Early pendulum exercises, gradual ROM under supervision.

• Avoid prolonged immobilization to prevent stiffness.