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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Anatomic Neck Fracture of Humerus

- vascular supply to the humeral head

- Two Part Articular Segment Displacement:
    - fracture plane is through the anatomic (not surgical neck);
    - anatomic neck represents the old eiphyseal plate;
    - surgical neck represents the weakened area below the tuberosities and head approximately 2 cm distal to the anatomic neck;
    - significant chondral defects and minimally separated fragments may go unappreciated on plain films;
    - through no soft tissue remains attached to the humeral head, the undisturbed blood supply transmitted through the tuberosities may prevent osteonecrosis of the articular segment;

- Treament:
    - ORIF vs. prosthetic arthroplasty;
    - in young active pts, consider screws from the shaft into head may be inserted thru an anterior approach;
    - it may prove difficult to obtain adequate screw purchase in the head fragment without violating the articular surface;
    - prosthetic hemiarthroplasty may be indicated in older pts;
         - deltopectoral approach with release of the subscapularis tendon from lesser tuberosity affords excellent exposure;
         - following removal of the head fragment and reaining of the shaft, the humeral component is implanted in 30 to 40 deg of retroversion relative the epicondyles of the elbow



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Saturday, June 23, 2012 6:08 pm