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Proximal Humeral Fractures

  • Martin Jaeger
  • N. P. Südkamp
Chapter
Part of the European Instructional Lectures book series (EICL, volume 12)

Abstract

Proximal humeral fractures are quite frequent, especially seen in elderly females with osteopenic bone structure. Based on precise diagnostics and a consequent classification of the fracture, it is possible to define an individual treatment protocol. Doing so it is very helpful to understand the individual pathomechanism leading to the fracture pattern that has to be addressed. Even today, proximal humeral fractures are treated non-operatively mostly. Operative treatment is challenging. In order to cover the entire variety of fractures it is necessary to perform all kinds of osteosyntheses, including K-Wires, nails, plates and both anatomic and inverse fracture prostheses.

Keywords

Rotator Cuff Humeral Head Proximal Humerus Biceps Tendon Proximal Humeral Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Court-Brown C, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697PubMedCrossRefGoogle Scholar
  2. 2.
    Péntek M, Horváth C, Boncz I, Falusi Z, Tóth E, Sebestyén A et al (2008) Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003. Osteoporos Int 19(2):243–249PubMedCrossRefGoogle Scholar
  3. 3.
    Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442(1):87–92PubMedCrossRefGoogle Scholar
  4. 4.
    Bahrs C, Schmal H, Lingenfelter E, Rolauffs B, Weise K, Dietz K et al (2008) Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study. BMC Musculoskelet Disord 9:21PubMedCrossRefGoogle Scholar
  5. 5.
    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(4):427–433PubMedCrossRefGoogle Scholar
  6. 6.
    Majed A, Macleod I, Bull AMJ, Zyto K, Resch H, Hertel R et al (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 20(7):1125–1132PubMedCrossRefGoogle Scholar
  7. 7.
    Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16(Suppl 2):S65–S72PubMedCrossRefGoogle Scholar
  8. 8.
    Bastian J, Hertel R (2008) Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 17(1):2–8PubMedCrossRefGoogle Scholar
  9. 9.
    Boileau P, Trojani C, Walch G, Krishnan S, Romeo A, Sinnerton R (2001) Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elbow Surg 10(4):299–308PubMedCrossRefGoogle Scholar
  10. 10.
    Boileau P, Chuinard C, Le Huec J-C, Walch G, Trojani C (2006) Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res 442:121–130PubMedCrossRefGoogle Scholar
  11. 11.
    Court-Brown CM, McQueen MM (2008) Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma 64(6):1517–1521PubMedCrossRefGoogle Scholar
  12. 12.
    Court-Brown CM, McQueen M (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. J Bone Joint Surg Am 91(11):2771; author reply 2771–2772PubMedGoogle Scholar
  13. 13.
    Iyengar JJ, Devcic Z, Sproul RC, Feeley BT (2011) Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma 25(10):612–617PubMedCrossRefGoogle Scholar
  14. 14.
    Fjalestad T, Hole MØ, Jørgensen JJ, Strømsøe K, Kristiansen IS (2010) Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients. Injury 41(6):599–605PubMedCrossRefGoogle Scholar
  15. 15.
    Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20(5):747–755PubMedCrossRefGoogle Scholar
  16. 16.
    Sanders RJ, Thissen LG, Teepen JC, van Kampen A, Jaarsma RL (2011) Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elbow Surg 20(7):1118–1124PubMedCrossRefGoogle Scholar
  17. 17.
    Jakob R, Miniaci A, Anson P, Jaberg H, Osterwalder A, Ganz R (1991) Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 73(2):295–298PubMedGoogle Scholar
  18. 18.
    Resch H (2011) Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 20(5):827–832PubMedCrossRefGoogle Scholar
  19. 19.
    Bergmann G, Graichen F, Rohlmann A, Westerhoff P, Bender A, Gabel U et al (2007) Loads acting on orthopaedic implants: measurements and practical applications. Orthopade 36(3):195–204PubMedCrossRefGoogle Scholar
  20. 20.
    Ogawa K, Kobayashi S, Ikegami H (2011) Retrograde intramedullary multiple pinning through the deltoid “V” for valgus-impacted four-part fractures of the proximal humerus. J Trauma 71(1):238–244PubMedCrossRefGoogle Scholar
  21. 21.
    Resch H, Povacz P, Frohlich R, Wambacher M (1997) Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 79(2):295–300PubMedCrossRefGoogle Scholar
  22. 22.
    Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172PubMedCrossRefGoogle Scholar
  23. 23.
    Blum J, Hansen M, Rommens PM (2009) Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail). Oper Orthop Traumatol 21(3):296–311PubMedCrossRefGoogle Scholar
  24. 24.
    Lanting B, Macdermid J, Drosdowech D, Faber K (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg 17(1):42–54PubMedCrossRefGoogle Scholar
  25. 25.
    Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M et al (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(6):1320–1328PubMedCrossRefGoogle Scholar
  26. 26.
    Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844PubMedCrossRefGoogle Scholar
  27. 27.
    Fjalestad T, Stromsoe K, Blucher J, Tennoe B (2005) Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg 125(5):310–316PubMedCrossRefGoogle Scholar
  28. 28.
    Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42(11):1283–1288PubMedCrossRefGoogle Scholar
  29. 29.
    Sudkamp NP, Audige L, Lambert S, Hertel R, Konrad G (2011) Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg 20(8):1207–1216PubMedCrossRefGoogle Scholar
  30. 30.
    Krappinger D, Roth T, Gschwentner M, Suckert A, Blauth M, Hengg C et al (2012) Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol 41(3):299–304, Epub 2011 Apr 21PubMedCrossRefGoogle Scholar
  31. 31.
    Tingart M, Apreleva M, von Stechow D, Zurakowski D, Warner J (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85(4):611–617PubMedCrossRefGoogle Scholar
  32. 32.
    Bastian J, Hertel R (2009) Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg 18(2):216–219PubMedCrossRefGoogle Scholar
  33. 33.
    Dietrich M, Meier C, Lattmann T, Zingg U, Gruninger P, Platz A (2008) Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty. Chirurg 79(3):231–240PubMedCrossRefGoogle Scholar
  34. 34.
    Fialka C, Stampfl P, Arbes S, Reuter P, Oberleitner G, Vécsei V (2008) Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems. J Shoulder Elbow Surg 17(2):210–215PubMedCrossRefGoogle Scholar
  35. 35.
    Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G et al (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 86(2):217–219PubMedCrossRefGoogle Scholar
  36. 36.
    Amirfeyz R, Sarangi P (2008) Shoulder hemiarthroplasty for fracture with a conservative rehabilitation regime. Arch Orthop Trauma Surg 128(9):985–988PubMedCrossRefGoogle Scholar
  37. 37.
    Cazeneuve JF, Cristofari D-J (2010) The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 92(4):535–539PubMedCrossRefGoogle Scholar
  38. 38.
    Klein M, Juschka M, Hinkenjann B, Scherger B, Ostermann PAW (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the delta III reverse shoulder prosthesis. J Orthop Trauma 22(10):698–704PubMedCrossRefGoogle Scholar
  39. 39.
    Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95(1):48–55PubMedCrossRefGoogle Scholar
  40. 40.
    Werner C, Steinmann P, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87(7):1476–1486PubMedCrossRefGoogle Scholar
  41. 41.
    Rockwood C (2007) The reverse total shoulder prosthesis. The new kid on the block. J Bone Joint Surg Am 89(2):233–235PubMedCrossRefGoogle Scholar
  42. 42.
    Boileau P, Watkinson D, Hatzidakis A, Hovorka I (2006) Neer award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15(5):527–540PubMedCrossRefGoogle Scholar
  43. 43.
    Favard L, Levigne C, Nerot C, Gerber C, Wilde L, Molé D (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469(9):2469–2475PubMedCrossRefGoogle Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic and Trauma SurgeryAlbert-Ludwigs-University of Freiburg, Medical SchoolFreiburg im BreisgauGermany

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