Four-part valgus impacted fractures of the proximal humerus

“…Such a minimal osteosynthesis is generally practiced in type III fractures, but it is also proposable in type IV fracture, especially in the subtype "four-part valgus impacted fracture" [11], avoiding to the patient, not necessarily only if young, the prosthetic replacement of the shoulder. In fact, it has been reported that 20% of type IV fractures have an excellent clinical result after osteosynthesis [12].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications

Rosa¹,

Maccauro²,

Nizegorodcew³

et al. 2002

J Orthopaed Traumatol

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IntroductionFractures of the proximal humerus represent 4%-5% of all fractures. Although they can occur anytime after birth, their incidence increases progressively with age, particularly in women, because of postmenopausal osteoporosis, so that about 80% of affected people older than 50 years are women [1].The most used classification of these fractures was developed by Neer [2] in 1970 ( Fig. 1), starting from Codman's classification, based on the four constitutive fragments of the proximal humerus (head, tuberosities and diaphysis). Neer integrated it with notions of biomechanics, i.e. the analysis of muscular forces displacing fracture, and of physiopathology, i.e. the evaluation of possible vascular deficits of the humeral head (Fig. 2) [3] following trauma. Therefore, this classification allows one to determine the prognosis of the fracture, the risk of necrosis of the humeral head and the expectation of functional recovery of the shoulder, and consequently to choose among conservative treatment, osteosynthesis and prosthetic replacement. More complex, and therefore less used, is the AO/ASIF classification (Fig. 3) [4].In 85% of cases, the fractures are composed, so that they can be treated conservatively with simple immobilization [5]. In the remaining 15%, there is indication to the surgical treatment but, as it is known, there are controversies both on which classification to use (Neer versus AO/ASIF), because neither is entirely reliable [6], and on which surgical technique to choose, because neither is effective in all cases, either for technical difficulties or for insufficient functional results.We report the short-term results of the elastic osteosynthesis with percutaneous threads, a method that differs from the traditional static assemblage because it causes compression and not only an alignment at the focus of fracture.

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“…Avascular necrosis of the humeral head after 4-part fractures could be a contributing factor to the inferior results (Lee and Hansen 1981). There is a specific type of displaced 4-part fracture with a valgus impaction of the humeral head, where the incidence of avascular necrosis is reduced and the outcome is more favorable (Jakob et al 1991).…”

Section: Hans Ersmarkl and Anders Sperber'mentioning

confidence: 99%

Poor reproducibility of classification of proximal humeral fractures: Additional CT of minor value

Sjödén

Movin

Güntner

et al. 1997

Acta Orthopaedica Scandinavica

131

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Four-part valgus impacted fractures of the proximal humerus

Cited by 301 publications

References 1 publication

Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures

Non-operative treatment versus tension-band osteosynthesis in three- and four-part proximal humeral fractures

Percutaneous elastic fixation of proximal humeral fractures: operative indications, techniques, results and complications

Poor reproducibility of classification of proximal humeral fractures: Additional CT of minor value

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