Proximal Humeral Fracture

- See: Proximal Humeral Physeal Injuries
- Discussion:
      - classification of proximal humeral fractures:
             - anatomic neck fracture:
             - one part fracture
             - two part fractures
                     - two part surgical neck fracture
                     - two part tuberosity fractures:
                            - lesser tuberosity frx;
                            - greater tuberosity frx;
             - three part fractures
             - four part fracture:
             - fracture dislocation:
             - head split fragment:
                      - Clinical and Radiographic Outcomes After Surgical Treatment of Proximal Humeral Fractures with Head-Split Component.t

    - displacing forces:
           - following frx of humerus, frx fragments may be displaced as a result of pull of muscles inserting into two parts;
           - w/ frx of surgical neck, upper frag is usually abducted and externally rotated by the muscles inserting onto greater tubercle,
                      while lower frag is adducted & internally rotated by internal rotators; (see rotator cuff);
           - in frx of shaft, angulation & overriding may result from muscular pull;
           - fractures of the middle & lower third of humeral shaft are frequently associated w/ injuries of the encircling radial nerve;

- Radiographs:
    - an axillary view is mandatory for proximal humeral fractures, as it is the view that shows the most angulation and displacement;
    - ref: Conservative management of proximal humeral fractures: can poor functional outcome be related to standard transscapular radiographic evaluation?


- Non Operative Treatment:
    - references:
           - Functional results following frx of proximal humerus. A controlled clinical study comparing two periods of immobilization.
           - Conservative treatment of fractures and fracture-dislocations of the upper end of the humerus.
           - Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus

- Operative Treatment of Proximal Humerus Fractures: 

            - Lateral Plating Technique
            - Shoulder Replacement

- Complications:
    - Non Union of Humeral Fractures:
    - Avascular Necrosis:
main indicators of AVN:
                  - calcar length ( <8 mm), medial hinge integrity, and anatomic neck fracture
           - Initial post-fracture humeral head ischemia does not predict development of necrosis
           - [Dislocated multiple fragment fractures of the head of the humerus. Does dislocation of the humeral head fragment signify a worse prognosis?].
           - Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus.
Complex proximal humerus fractures: Hertel's criteria reliability to predict head necrosis.

    - Vascular Complications:

           - Axillary artery injury secondary to displaced proximal humeral fractures: a report of two cases.
           - Axillary artery injury from humeral neck fracture: a rare but disabling traumatic event 
           - Axillary artery injury after proximal humeral fracture: a review of 2 cases.
           - Vascular Injury Accompanying Displaced Proximal Humeral Fractures: Two Cases and a Review of the Literature
           - Proximal humerus fractures with associated axillary artery injury.
           - Proximal humerus fracture with injury to the axillary artery: a population-based study.   
           - Delayed Radial Nerve Injury from a Brachial Artery Pseudoaneurysm Following a Four-Part Proximal Humerus Fracture: A Case Report and Literature Review.

Job 31:22 (King James Version): Then let mine arm fall from my shoulder blade, and mine arm be broken from the bone.

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

Last updated by Data Trace Staff on Thursday, March 26, 2020 11:15 pm