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Anatomic Neck Fracture of Humerus

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;


  • 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