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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006;37:691–7.
Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72:365–71.
Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Cin Orthop 2006; 442:87–92.
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.
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.
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.
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.
Neer CS II. Displaced proximal humeral fractures. Part I. Classifi cation and evaluation. J Bone Joint Surg Am 1970;52:1077–89.
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.
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.
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.
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.
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.
Codman EA. The Shoulder, 2nd ed. Malabar: RE Krieger, 1984, pp 313–31.
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.
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.
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.
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.
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.
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.
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.
Torrens C, Melendo E, Solano A, Caceres E. Two-part bitu-berosity proximal humeral fracture. A case report. J Trauma 2008.
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.
Neer CS II. Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg 2002;11:389–400.
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.
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.
Zyto K. Non-operative treatment of comminuted fractures of the proximal hmerus in elderly patients. Injury 1998;29:349–52.
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.
Gerber C, Werner CML, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br 2004;86:848–55.
Resch H, Beck E, Bayley I. Reconstruction of the valgus-impacted humeral head fracture. J Shoulder Elbow Surg 1995; 4:73–80.
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.
Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures. J Bone Joint Surg Br 1993;75:132–6.
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.
Bastian JD, Hertel R. Initial post-fracture humeral ischemia does not predict development of necrosis. J Shoulder Elbow Surg 2008;17:2–8.
Smith AM, Mardones RM, Sperling JW, Cofield RH. Early complications of operatively treated proximal humeral fractures. J Shoulder Elbow Surg 2007;16:14–24.
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.
Gaebler C, McQueen MM, Court-Brown CM. Minimally displaced proximal humeral fractures. Acta Orthop Scand 2003;74:580–5.
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.
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.
Dimakopoulos P, Panagopoulos A, Kasimatis G. Transosseous suture fixation of proximal humeral fractures. J Bone Joint Surg Am 2007;89:1700–9.
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.
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.
Lin J, Hou S-M, Hang Y-S. Locked nailing for displaced surgical neck fractures of the humerus. J Trauma 1998;45:1051–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Torrens C, Corrales M, Melendo E, Solano A, RodrÃguez-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.
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.
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.
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.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights 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)