International Orthopaedics

, Volume 38, Issue 7, pp 1451–1459 | Cite as

The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device

  • Stefano Carbone
  • Philipp Moroder
  • Valerio Arceri
  • Roberto Postacchini
  • Stefano Gumina
Original Paper



The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock.


Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up.


Forty-three fractures were available for follow-up. The amount of humeral head impaction was 3.9 mm on average and was directly correlated with patient’s age, sex, Codman-Lego classification, varus inclination and mataphyseal comminution. The postoperative cervico-diaphyseal angle was restored in 35 cases, with 81 % good results. The Humerusblock was removed in 41 % of cases because of K-wire perforation of the humeral head. A negative correlation was found between impaction and Constant score.


The amount of humeral head impaction is related to patients’ age, sex, and fracture patterns, being the most prone to compaction those with metaphyseal comminution. Humeral head impaction negatively affects final Constant score.


Proximal humerus fractures Humeral head impaction Sintering Humerusblock Metaphyseal comminution Calculation of head impaction Complications 


Conflict of interest

No support and disclaimer to declare.

Supplementary material


(WMV 5294 kb)


  1. 1.
    Roux A, Decroocq L, El BAtti S, Bonnevialle N, Moineau G, Trojani C, Boileau P, de Peretti F (2012) Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 98:715–719. doi: 10.1016/j.otsr.2012.05.013 PubMedCrossRefGoogle Scholar
  2. 2.
    Fankhauser F, Boldin C, Schippinger G, Haunschmid C, Szyszkowitz R (2005) A new locking plate for unstable fractures of the proximal humerus. Clin Orthop Relat Res 430:176–181PubMedCrossRefGoogle Scholar
  3. 3.
    Rouleau DM, Laflamme GY, Berry GK, Harvey EJ, Delisle J, Girard J (2009) Proximal humerus fractures treated by percutaneous locking plate internal fixation. Orthop Traumatol Surg Res 95:56–62. doi: 10.1016/j.otsr.2008.09.003 PubMedCrossRefGoogle Scholar
  4. 4.
    Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M (2012) Surgical treatment of Neer Group VI proximal humeral fractures: retrospective comparison of PHILOS® and hemiarthroplasty. Clin Orthop Relat Res 470:2035–2042. doi: 10.1007/s11999-011-2207-1 PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Bogner R, Hubner C, Matis N, Auffarth A, Lederer S, Resch H (2008) Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg (Br) 90:1602–1607CrossRefGoogle Scholar
  6. 6.
    Resch H, Beck E, Bayley J (1995) Reconstruction of valgus impacted humeral head fractures—indication, technique and long term results. J Shoulder Elbow Surg 4:73–80PubMedCrossRefGoogle Scholar
  7. 7.
    Owsley KC, Gorczyca JT (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am 90:233–240. doi: 10.2106/JBJS.F.01351 PubMedCrossRefGoogle Scholar
  8. 8.
    Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91:1320–1328. doi: 10.2106/JBJS.H.00006 PubMedCrossRefGoogle Scholar
  9. 9.
    Jost B, Spross C, Grehn H, Gerber C (2011) Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 22:542–549. doi: 10.1016/j.jse.2012.06.008 CrossRefGoogle Scholar
  10. 10.
    Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288. doi: 10.1016/j.injury.2011.01.017 PubMedCrossRefGoogle Scholar
  11. 11.
    Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C (2013) Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg 22:e8–e14. doi: 10.1016/j.jse.2012.04.002 PubMedCrossRefGoogle Scholar
  12. 12.
    Resch H, Hubner C, Schwaiger R (2001) Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury 32:25–32CrossRefGoogle Scholar
  13. 13.
    Bergmann G, Graichen F, Bender A, Kääb M, Rohlmann A, Westerhoff P (2007) In vivo glenohumeral contact forces–measurements in the first patient 7 months postoperatively. J Biomech 40:2139–2149PubMedCrossRefGoogle Scholar
  14. 14.
    Vundelinckx BJ, Dierickx CA, Bruckers L, Dierickx CH (2012) Functional and radiographic medium-term outcome evaluation of the Humerus Block, a minimally invasive operative technique for proximal humeral fractures. J Shoulder Elbow Surg 21:1197–1206. doi: 10.1016/j.jse.2011.07.029 PubMedCrossRefGoogle Scholar
  15. 15.
    Brunner A, Weller K, Thormann S, Jöckel JA, Babst R (2010) Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma 24:407–413. doi: 10.1097/BOT.0b013e3181c81b1c PubMedCrossRefGoogle Scholar
  16. 16.
    Resch H (2011) Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 20:827–832. doi: 10.1016/j.jse.2011.01.009 PubMedCrossRefGoogle Scholar
  17. 17.
    Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG (2007) The importance of the medial support in locked plating of proximal humerus fracture. J Orthop Trauma 21:185–191. doi: 10.1097/BOT.0b013e3180333094 PubMedCrossRefGoogle Scholar
  18. 18.
    Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91:1689–1697. doi: 10.2106/JBJS.H.00133 PubMedCrossRefGoogle Scholar
  19. 19.
    Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433. doi: 10.1016/j.jse.2004.01.034 PubMedCrossRefGoogle Scholar
  20. 20.
    Majed A, Macleod I, Bull AM, Zyto K, Resch H, Hertel R, Reilly P, Emery RJ (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 20:1125–1132. doi: 10.1016/j.jse.2011.01.020 PubMedCrossRefGoogle Scholar
  21. 21.
    Bahrs C, Rolauffs B, Dietz K, Eingartner C, Weise K (2010) Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg 130:673–679. doi: 10.1007/s00402-009-0975-9 PubMedCrossRefGoogle Scholar
  22. 22.
    Hertel R, Knothe U, Ballmer FT (2002) Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elbow Surg 11:331–338. doi: 10.1067/mse.2002.124429 PubMedCrossRefGoogle Scholar
  23. 23.
    Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  24. 24.
    Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V (2013) Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 22:1650–1655. doi: 10.1016/j.jse.2013.05.002 PubMedCrossRefGoogle Scholar
  25. 25.
    Landis JR, Koch GC (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  26. 26.
    Roberts VI, Komarasamy B, Pandey R (2012) Modification of the Resch procedure: a new technique and its results in managing three- and four-part proximal humeral fractures. J Bone Joint Surg (Br) 94:1409–1413. doi: 10.1302/0301-620X.94B10.28692 CrossRefGoogle Scholar
  27. 27.
    Carbone S, Tangari M, Gumina S, Postacchini R, Campi A, Postacchini F (2012) Percutaneous pinning of 3-or 4-part fractures of proximal humerus in elderly patients in poor general conditions: MIROS® versus traditional pinning. Int Orthop 36:1267–1273. doi: 10.1007/soo264-011-1474-5 PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Galatz LM, Kim HM (2007) Minimally invasive techniques for proximal humerus fractures. In: Iannotti JP, Willams GR (eds) Disorders of the shoulder, vol 2, 2nd edn. Lippincott Willams & Wikkins, Philadelphia, pp 873–888Google Scholar
  29. 29.
    Russo R, Cautiero F, Della Rotonda G (2012) The classification of complex 4-part humeral fractures revisited: the missing fifth fragment and indications for surgery. Musculoskelet Surg 96(Suppl 1):S13–S19. doi: 10.1007/s12306-012-0195-2 PubMedCrossRefGoogle Scholar
  30. 30.
    Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7:586–590PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Stefano Carbone
    • 1
  • Philipp Moroder
    • 2
  • Valerio Arceri
    • 1
  • Roberto Postacchini
    • 3
  • Stefano Gumina
    • 1
  1. 1.Department of Orthopaedics and TraumatologySapienza University of RomeRomeItaly
  2. 2.Paracelsus Medizinische PrivatuniversitätUniversitätsklinik für Unfallchirurgie und SporttraumatologieSalzburgAustria
  3. 3.Ospedale Israelitico, Shoulder UnitRomeItaly

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