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Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 4/2011

01-12-2011 | Modern Techniques in Shoulder Surgery (Lawrence V. Gulotta, Section Editor)

Proximal humeral fractures

Author: Craig S. Mauro

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2011

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Abstract

Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percutaneous or open techniques to arthroplasty reconstructions. This article reviews the current literature on the classification and treatment options for proximal humeral fractures, while seeking to help the reader to define the most appropriate treatment plan for each individual patient with this type of fracture.
Literature
1.
2.
Neer 2nd CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077–89.PubMed
3.
Müller ME. Appendix A: the comprehensive classification of fractures of long bones. In: Müller ME, Allgöwer M, Schneider R, Willenegger H, editors. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. Berlin: Springer; 1991. p. 118–25.
4.
Sidor ML, Zuckerman JD, Lyon T, et al. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75:1745–50.PubMed
5.
Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am. 1993;75:1751–5.PubMed
6.
Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13:427–33.PubMedCrossRef
7.
Murray IR, Amin AK, White TO, Robinson CM. Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br. 2011;93:1–11.PubMed
8.
Voos JE, Dines JS, Dines DM. Arthroplasty for fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2010;92:1560–7.PubMed
9.
Koval KJ, Gallagher MA, Marsicano JG, et al. Functional outcome after minimally displaced fractures of the proximal part of the humerus. J Bone Joint Surg Am. 1997;79:203–7.PubMed
10.
Kristiansen B, Angermann P, Larsen TK. Functional results following fractures of the proximal humerus. A controlled clinical study comparing two periods of immobilization. Arch Orthop Trauma Surg. 1989;108:339–41.PubMedCrossRef
11.
Poeze M, Lenssen AF, Van Empel JM, Verbruggen JP. Conservative management of proximal humeral fractures: can poor functional outcome be related to standard transscapular radiographic evaluation? J Shoulder Elbow Surg. 2010;19:273–81.PubMedCrossRef
12.
Tejwani NC, Liporace F, Walsh M, et al. Functional outcome following one-part proximal humeral fractures: a prospective study. J Shoulder Elbow Surg. 2008;17:216–9.PubMedCrossRef
13.
Bosch U, Skutek M, Fremerey RW, Tscherne H. Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Shoulder Elbow Surg. 1998;7:479–84.PubMedCrossRef
14.
Bogner R, Hubner C, Matis N, et al. Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br. 2008;90:1602–7.PubMedCrossRef
15.
Resch H. Proximal humeral fractures: current controversies. J Shoulder Elbow Surg. 2011; In press.
16.
Resch H, Hubner C, Schwaiger R. Minimally invasive reduction and osteosynthesis of articular fractures of the humeral head. Injury. 2001;32 Suppl 1:SA25–32.PubMed
17.
Resch H, Povacz P, Frohlich R, Wambacher M. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br. 1997;79:295–300.PubMedCrossRef
18.
Brunner A, Weller K, Thormann S, et al. Closed reduction and minimally invasive percutaneous fixation of proximal humerus fractures using the Humerusblock. J Orthop Trauma. 2010;24:407–13.PubMedCrossRef
19.
Keener JD, Parsons BO, Flatow EL, et al. Outcomes after percutaneous reduction and fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2007;16:330–8.PubMedCrossRef
20.
Fenichel I, Oran A, Burstein G, Perry Pritsch M. Percutaneous pinning using threaded pins as a treatment option for unstable two- and three-part fractures of the proximal humerus: a retrospective study. Int Orthop. 2006;30:153–7.PubMedCrossRef
21.
Nho SJ, Brophy RH, Barker JU, et al. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am. 2007;89 Suppl 3:44–58.PubMedCrossRef
22.
Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal humerus. J Orthop Trauma. 2008;22:132–7.PubMedCrossRef
23.
Robinson CM, Khan L, Akhtar A, Whittaker R. The extended deltoid-splitting approach to the proximal humerus. J Orthop Trauma. 2007;21:657–62.PubMedCrossRef
24.
Konrad G, Bayer J, Hepp P, et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt):85–95.PubMedCrossRef
25.
Robinson CM, Wylie JR, Ray AG, et al. Proximal humeral fractures with a severe varus deformity treated by fixation with a locking plate. J Bone Joint Surg Br. 2010;92:672–8.PubMedCrossRef
26.
Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma. 2008;22:195–200.PubMedCrossRef
27.
• Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23:163–72. Open reduction and internal fixation leads to good functional outcomes, but a high rate of complications may be experienced.PubMedCrossRef
28.
Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma. 2009;23:113–9.PubMedCrossRef
29.
Sudkamp N, Bayer J, Hepp P, et al. 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. 2009;91:1320–8.PubMedCrossRef
30.
Bigorre N, Talha A, Cronier P, et al. A prospective study of a new locking plate for proximal humeral fracture. Injury. 2009;40:192–6.PubMedCrossRef
31.
Geiger EV, Maier M, Kelm A, et al. Functional outcome and complications following PHILOS plate fixation in proximal humeral fractures. Acta Orthop Traumatol Turc. 2010;44:1–6.PubMedCrossRef
32.
Duralde XA, Leddy LR. The results of ORIF of displaced unstable proximal humeral fractures using a locking plate. J Shoulder Elbow Surg. 2010;19:480–8.PubMedCrossRef
33.
Adedapo AO, Ikpeme JO. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury. 2001;32:115–21.PubMedCrossRef
34.
Agel J, Jones CB, Sanzone AG, et al. Treatment of proximal humeral fractures with Polarus nail fixation. J Shoulder Elbow Surg. 2004;13:191–5.PubMedCrossRef
35.
Georgousis M, Kontogeorgakos V, Kourkouvelas S, et al. Internal fixation of proximal humerus fractures with the polarus intramedullary nail. Acta Orthop Belg. 2010;76:462–7.PubMed
36.
Rajasekhar C, Ray PS, Bhamra MS. Fixation of proximal humeral fractures with the Polarus nail. J Shoulder Elbow Surg. 2001;10:7–10.PubMedCrossRef
37.
Iacobellis C, Serafini D, Aldegheri R. PHN for treatment of proximal humerus fractures: evaluation of 80 cases. Chir Organi Mov. 2009;93:47–56.PubMed
38.
Kazakos K, Lyras DN, Galanis V, et al. Internal fixation of proximal humerus fractures using the Polarus intramedullary nail. Arch Orthop Trauma Surg. 2007;127:503–8.PubMedCrossRef
39.
Gradl G, Dietze A, Kaab M, et al. Is locking nailing of humeral head fractures superior to locking plate fixation? Clin Orthop Relat Res. 2009;467:2986–93.PubMedCrossRef
40.
Krishnan SG, Bennion PW, Reineck JR, Burkhead WZ. Hemiarthroplasty for proximal humeral fracture: restoration of the Gothic arch. Orthop Clin North Am. 2008;39:441–50. vi.PubMedCrossRef
41.
Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007;89:292–300.PubMedCrossRef
42.
Willis M, Min W, Brooks J, et al. Proximal humeral malunion treated with reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2011; In press.
43.
Martin TG, Iannotti JP. Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humeral fractures. Orthop Clin North Am. 2008;39:451–7. vi.PubMedCrossRef
44.
Dines DM, Warren RF. Modular shoulder hemiarthroplasty for acute fractures. Surgical considerations. Clin Orthop Relat Res. 1994;18–26.
45.
Neer 2nd CS. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52:1090–103.PubMed
46.
Boileau P, Krishnan SG, Tinsi L, et al. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002;11:401–12.PubMedCrossRef
47.
Frankle MA, Ondrovic LE, Markee BA, et al. Stability of tuberosity reattachment in proximal humeral hemiarthroplasty. J Shoulder Elbow Surg. 2002;11:413–20.PubMedCrossRef
48.
Abu-Rajab RB, Stansfield BW, Nunn T, et al. Re-attachment of the tuberosities of the humerus following hemiarthroplasty for four-part fracture. J Bone Joint Surg Br. 2006;88:1539–44.PubMedCrossRef
49.
Krause FG, Huebschle L, Hertel R. Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-month minimum follow-up. J Orthop Trauma. 2007;21:682–6.PubMedCrossRef
50.
Dines DM, Warren RF, Altchek DW, Moeckel BH. Posttraumatic changes of the proximal humerus: Malunion, nonunion, and osteonecrosis.Treatment with modular hemiarthroplasty or total shoulder arthroplasty. J Shoulder Elbow Surg. 1993;2:11–21.CrossRef
51.
Sirveaux F, Navez G, Roche O, et al. Reverse prosthesis for proximal humerus fracture, technique and results. Tech Shoulder Elbow Surg. 2008;9:15–22.CrossRef
52.
Robinson CM, Page RS, Hill RM, et al. Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003;85-A:1215–23.PubMed
53.
Kralinger F, Schwaiger R, Wambacher M, et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br. 2004;86:217–9.PubMedCrossRef
54.
Reuther F, Muhlhausler B, Wahl D, Nijs S. Functional outcome of shoulder hemiarthroplasty for fractures: A multicentre analysis. Injury. 2010;41:606–12.PubMedCrossRef
55.
Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90:1407–13.PubMedCrossRef
56.
Klein M, Juschka M, Hinkenjann B, et al. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma. 2008;22:698–704.PubMedCrossRef
57.
Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br. 2007;89:516–20.PubMedCrossRef
58.
Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527–40.PubMedCrossRef
59.
Cazeneuve JF, Cristofari DJ. Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2006;92:543–8.PubMedCrossRef
60.
• Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br. 2010;92:535–9. This report presents the first long-term outcome of the use of reverse shoulder arthroplasty in the treatment of acute complex proximal humeral fractures in the elderly.PubMedCrossRef
61.
Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009;18:612–21.PubMedCrossRef
Metadata
Title
Proximal humeral fractures
Author
Craig S. Mauro
Publication date
01-12-2011
Publisher
Current Science Inc.
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2011
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-011-9094-7

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