Skip to main content

Proximal Humeral Fractures

  • Chapter
European Instructional Lectures
  • 1136 Accesses

Despite more than 3,000 articles published proximal humeral fractures remain diffi cult to defi ne and classify, natural evolution has been poorly defi ned and the best treatment option is yet to be established. Current trends in management of these complex fractures are analyzed and rationale decision-making is presented.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006;37:691–7.

    Article  PubMed  Google Scholar 

  2. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72:365–71.

    Article  PubMed  CAS  Google Scholar 

  3. Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Cin Orthop 2006; 442:87–92.

    Article  Google Scholar 

  4. Schwartz AV, Nevitt MC, Brown BW, Kelsey JL. Increased falling as a risk factor for fracture among older women. Am J Epidemiol 2005;161:180–5.

    Article  PubMed  Google Scholar 

  5. Chu SP, Kelsey JL, Keegan THM, Sternfeld B, Prill M, Quesenberry CP, Sidney S. Risk factors for proximal humeral fracture. Am J Epidemiol 2004;160:360–7.

    Article  PubMed  Google Scholar 

  6. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B. Mortality after osteo-porotic fractures. Osteoporos Int 2004;15:38–42.

    Article  PubMed  CAS  Google Scholar 

  7. Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B. Fracture risk following an osteoporotic fracture. Osteoporos Int 2004;15:175–9.

    Article  PubMed  CAS  Google Scholar 

  8. Neer CS II. Displaced proximal humeral fractures. Part I. Classifi cation and evaluation. J Bone Joint Surg Am 1970;52:1077–89.

    PubMed  Google Scholar 

  9. Castagno AA, Shuman WP, Kilcoyne RF, Haynor DR, Morris ME, Matsen FA. Complex fractures of the proximal humerus: role of CT in the treatment. Radiology 1987;165:759–62.

    PubMed  CAS  Google Scholar 

  10. Parsons BO, Klepps SJ, Miller S, Bird J, Gladstone J, Flatow E. Reliability and reproducibility of radiographs of greater tuber-osity displacement. A cadaveric study. J Bone Joint Surg Am 2005;87:58–65.

    Article  PubMed  Google Scholar 

  11. Hertel R, Hempfing A, Stiehler M, Leuning M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 2004;13:427–33.

    Article  PubMed  CAS  Google Scholar 

  12. Shrader MW, Sanchez-Sotelo J, Sperling JW, Rowland CM, Cofield R. Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg 2005;14:497–505.

    Article  PubMed  Google Scholar 

  13. Mora JM, Sanchez A, Vila J, Cañete E, Gamez F. Proposed protocol for reading images of humeral head fractures. Clin Orthop 2006;448:225–33.

    Article  Google Scholar 

  14. Codman EA. The Shoulder, 2nd ed. Malabar: RE Krieger, 1984, pp 313–31.

    Google Scholar 

  15. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group, 3rd ed. Berlin: Springler, 1991, pp 118–25.

    Google Scholar 

  16. Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am 1993;75:1751–5.

    PubMed  CAS  Google Scholar 

  17. Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures. J Bone Joint Surg Am 1993;75:1745–50.

    PubMed  CAS  Google Scholar 

  18. Sidor ML, Zuckerman JD, Lyon T, Koval K, Schoenberg N. Classification of proximal humerus fractures: the contribution of the scapular lateral and axillary radiographs. J Shoulder Elbow Surg 1994;3:24–7.

    Article  Google Scholar 

  19. Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomo-graphic scans and plain radiographs. J Bone Joint Surg Am 1996;78:1371–5.

    PubMed  CAS  Google Scholar 

  20. Sjödén GO, Movin T, Günter P, Aspelin P, Ahrengart L, Ersmark H, Sperber A. Poor reproducibility of classification of proximal humeral fractures. Acta Orthop Scand 1997;68:239–42.

    Article  PubMed  Google Scholar 

  21. Sjödén GO, Movin T, Aspelin P, Günter P, Shalabi A. 3D-radiographic analysis does not improve the Neer and AO classifications of the proximal humeral fractures. Acta Orthop Scand 1999;70:325–8.

    PubMed  Google Scholar 

  22. Torrens C, Melendo E, Solano A, Caceres E. Two-part bitu-berosity proximal humeral fracture. A case report. J Trauma 2008.

    Google Scholar 

  23. Jakob RP, Miniaci A, Anson PS, Jaberg H, Osterwalder A, Ganz R. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 1991;73:295–8.

    PubMed  CAS  Google Scholar 

  24. Neer CS II. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 2002;11:389–400.

    Article  PubMed  Google Scholar 

  25. Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proximal humeral fractures: a systematic review of reatment modalities. J Shoulder Elbow Surg 2008;17:42–54.

    Article  PubMed  Google Scholar 

  26. Edelson G, Safuri H, Salami J, Vigder F, Militianu D. Natural history of complex fractures of the proximal humerus using a three-dimensional classification system. J Shoulder Elbow Surg 2008;17:399–409.

    Article  PubMed  Google Scholar 

  27. Zyto K. Non-operative treatment of comminuted fractures of the proximal hmerus in elderly patients. Injury 1998;29:349–52.

    Article  PubMed  CAS  Google Scholar 

  28. Zyto K, Ahrengart L, Sperber A, Törnkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 1997;79:412–7.

    Article  PubMed  CAS  Google Scholar 

  29. Gerber C, Werner CML, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 2004;86:848–55.

    Article  PubMed  CAS  Google Scholar 

  30. Resch H, Beck E, Bayley I. Reconstruction of the valgus-impacted humeral head fracture. J Shoulder Elbow Surg 1995; 4:73–80.

    Article  PubMed  CAS  Google Scholar 

  31. Gerber C, Schneeberger AG, Vinh JS. The arterial vascular-ization of the humeral head. An anatomical study. J Bone Joint Surg Am 1990;72:1486–94.

    PubMed  CAS  Google Scholar 

  32. Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures. J Bone Joint Surg Br 1993;75:132–6.

    PubMed  CAS  Google Scholar 

  33. Hertel R, Hempfing M, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 2004;13:427–33.

    Article  PubMed  CAS  Google Scholar 

  34. Bastian JD, Hertel R. Initial post-fracture humeral ischemia does not predict development of necrosis. J Shoulder Elbow Surg 2008;17:2–8.

    Article  PubMed  Google Scholar 

  35. Smith AM, Mardones RM, Sperling JW, Cofield RH. Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg 2007;16:14–24.

    Article  PubMed  CAS  Google Scholar 

  36. Koval K, Gallagher MA, Marsicano JG, Cuomo F, McShinany A, Zuckerman JD. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am 1997;79:203–7.

    PubMed  CAS  Google Scholar 

  37. Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures. Acta Orthop Scand 2003;74:580–5.

    Article  PubMed  Google Scholar 

  38. Tejwani NC, Liporace F, Walsh M, France MA, Zuckerman JD, Egol KA. Functional outcome following one-part proximal humeral fractures: a prospective study. J Shoulder Elbow Surg 2008;17:216–9.

    Article  PubMed  Google Scholar 

  39. Lefevre-Colau MM, Babinet A, Fayad F, Fermanian J, Anract P, Roren A, Kansao J, Revel M, Poiraudeau S. Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. J Bone Joint Surg Am 2007;89:2582–90.

    Article  PubMed  CAS  Google Scholar 

  40. Dimakopoulos P, Panagopoulos A, Kasimatis G. Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am 2007;89:1700–9.

    Article  PubMed  Google Scholar 

  41. Cuomo F, Flatow EL, Maday MG, Miller SR, McIlveen SJ, Bigliani LU. Open reduction and internal fixation of two-and three-part displaced surgical neck fractures of the proximal humerus. J Shoulder Elbow Surg 1992;1:287–95.

    Article  Google Scholar 

  42. Esser RD. Treatment of three- and four-part fractures of the proximal humerus with a modified cloverleaf plate. J Orthop Trauma 1994;8:15–22.

    Article  PubMed  CAS  Google Scholar 

  43. Lin J, Hou S-M, Hang Y-S. Locked nailing for displaced surgical neck fractures of the humerus. J Trauma 1998;45:1051–7.

    Article  PubMed  CAS  Google Scholar 

  44. Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R. A new locking plate for unestable fractures of the proximal humerus. Clin Orthop 2005;430:176–81.

    PubMed  Google Scholar 

  45. Koukakis A, Apostolou CD, Taneja T, Korres DS, Amini A. Fixation of proximal humerus fractures using the Philos plate. Clin Orthop 2006;442:116–20.

    Google Scholar 

  46. Moonot P, Ashwood N, Hamlet M. Early results for treatment of three- and four-part fractures of the proximal humerus using the Philos plate system. J Bone Joint Surg Br 2007; 89:1206–9.

    Article  PubMed  CAS  Google Scholar 

  47. Handschin AE, Cardell M, Contaldo C, Trentz O, Wanner GA. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury 2008;39:306–13.

    Article  PubMed  Google Scholar 

  48. Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD. Early complications in proximal humerus fractures (OTA types 11) treated with locked plates. J Orthop Trauma 2008;22:159–64.

    Article  PubMed  Google Scholar 

  49. Owsley KC, Gorczyca JT. Displacement/screw cutout after open reduction and locked plate fixation of humeral fractures. J Bone Joint Surg Am 2008;90:233–40.

    Article  PubMed  Google Scholar 

  50. Neer CS II. Displaced proximal humeral fractures. Part II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970;52:1090–103.

    PubMed  Google Scholar 

  51. Antuña SA, Sperling JW, Cofield RH. Shoulder hemiarthro-plasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow 2008;17:202–9.

    Article  Google Scholar 

  52. Grönhagen CM, Abbaszadegan H, Révay SA, Adolphson PY. Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg 2007;16:766–73.

    Article  PubMed  Google Scholar 

  53. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 2002;11:401–12.

    Article  PubMed  CAS  Google Scholar 

  54. Hempfing A, Leunig M, Ballmer FT, Hertel R. Surgical landmarks to determine humeral head retrotorsion for hemiarthro-plasty in fractures. J Shoulder Elbow Surg 2001;10:460–3.

    Article  PubMed  CAS  Google Scholar 

  55. Angibaud L, Zuckerman JD, Flurin PH, Roche C, Wright T. Reconstructing proximal humeral fractures using the bicipi-tal groove as a landmark. Clin Orthop 2007;458:168–74.

    PubMed  Google Scholar 

  56. Itamura J, Dietrick T, Roidis N, Shean C, Tibone J. Analysis of the bicipital groove as a landmark for humeral head replacement. J Shoulder Elbow Surg 2002;11:322–6.

    Article  PubMed  Google Scholar 

  57. Murachovsky J, Ikemoto RY, Nascimento LGP, Fujiki EN, Milani C, Warner JJP. Pectoralis major tendon reference (PMT): a new method for accurate restoration of humeral length with hemiarthroplasty for fracture. J Shoulder Elbow Surg 2006;15:675–8.

    Article  PubMed  Google Scholar 

  58. Greiner SH, Kääb MJ, Kröning I, Scheibel M, Perka C. Reconstruction of humeral length and centering of the prosthetic head in hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 2008;17:709–14.

    Article  PubMed  Google Scholar 

  59. Torrens C, Corrales M, Melendo E, Solano A, Rodríguez-Baeza A, Caceres E. Pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiartro-plasty for fracture. J Shoulder Elbow Surg 2008;17:947–50.

    Article  PubMed  Google Scholar 

  60. Frankle MA, Ondrovic LE, Markee BA, Harris ML, Lee WE III. Stability of tuberosity reattachment in proximal humeral hemiarthroplasty. J Shoulder Elbow Surg 2002;11:413–20.

    Article  PubMed  Google Scholar 

  61. De Wilde LF, Berghs BM, Beutler T, Ferguson SJ, Verdonk RC. A new prosthetic design for proximal humeral fractures: reconstructing the glenohumeral unit. J Shoulder Elbow Surg 2004;13:373–80.

    Article  PubMed  Google Scholar 

  62. Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 2007;89:516–20.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Torrens, C. (2009). Proximal Humeral Fractures. In: Bentley, G. (eds) European Instructional Lectures. European Federation of National Associations of Orthopaedics and Traumatology, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00966-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-00966-2_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-00965-5

  • Online ISBN: 978-3-642-00966-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics