Fracture of the neck of the humerus with dislocation of the head fragment

Neer, Charles S.; Brown, Thomas H.; McLaughlin, Harrison L.

doi:10.1016/0002-9610(53)90606-0

Cited by 134 publications

(42 citation statements)

References 3 publications

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“…Glenohumeral motion is dependent upon the fulcrum action of the humeral head and, contrary to previous belief [2,3,5], excision of the humeral head does not result in acceptable function [6]. So far, results of the operation described have been found to be superior to those of head resection.…”

Section: Discussionmentioning

confidence: 63%

“…The original prosthesis has been modified to include a three-flange mechanism at the neck which adds fixation and eliminates rotation. A hole is placed in the neck so that the fragments of the tuberosity are held together and to the prosthesis in fresh fracture-dislocations [6] (Fig. 1).…”

Section: Design Of the Prosthesismentioning

confidence: 99%

“…These lesions consistently follow a four-fragment pattern [1,3,6]: (1) the detached head, extracapsular and often rotated as much as 180 degrees; (2) the greater tuberosity, retracted posteriorly by the external rotators; (3) the lesser tuberosity, pulled medially by the subscapularis tendon; and (4) the shaft. A hole is present in the neck of the appliance, so that the tuberosities can be secured to the prosthesis as they are approximated (Fig.…”

Section: Techniquementioning

confidence: 99%

“…In an earlier study the late results of twenty unimpacted fracture-dislocations treated by reduction, excision of the head, or arthrodesis were found unsatisfactory [6]. Reduction was followed by avascular necrosis, because the head was devoid of soft-tissue attachments.…”

mentioning

confidence: 96%

“…Replacement by a prosthesis presented a logical solution. The initial prosthesis [6] had been designed for the treatment of these injuries.…”

mentioning

confidence: 99%

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The Classic: Articular Replacement for the Humeral Head

Neer

2011

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 63%

Section: Design Of the Prosthesismentioning

confidence: 99%

Section: Techniquementioning

confidence: 99%

mentioning

confidence: 96%

“…Replacement by a prosthesis presented a logical solution. The initial prosthesis [6] had been designed for the treatment of these injuries.…”

mentioning

confidence: 99%

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The Classic: Articular Replacement for the Humeral Head

Neer

2011

Clinical Orthopaedics &Amp; Related Research

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Arthroplasty for Proximal Humerus Fractures, Nonunions, and Malunions

Lee

Flatow

Shoulder Arthroplasty

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Treatment of complex fractures and fracture-dislocations of the proximal humerus in both the acute and late settings represent some of the most difficult injuries to assess and treat in the shoulder girdle. While the vast majority of proximal humerus fractures (more than 85%) are nondisplaced and amenable to nonoperative treatment, the remaining minority may involve multiple fragments or parts, comminution, and articular surface damage and represent a significant therapeutic challenge.Based on Codman's anatomical description of fractures about the proximal humerus [1], Neer [2] published a comprehensive four-part classification scheme of these complex injuries in 1970. Wide use of this system has allowed for more uniformity in evaluation and has directed treatment in this area for the last three decades.In conjunction with adequate evaluation of the proximal humeral anatomy, whether it is an acute fracture or the sequelae of an old injury, the therapeutic course should be guided by the surgical goal of anatomic restoration of the proximal humerus and patient-determined factors, such as age, function, and quality of remaining bone. With respect to acute fractures, all two-part, most three-part, and some fourpart fractures are well treated by closed reduction or open reduction and internal fixation techniques. When soft bone, impaired head vascularity, or articular damage make fixation difficult or ill-advised, prosthetic arthroplasty is a reasonable option.Use of a humeral head prosthesis for proximal humerus fractures was first reported in the 1950s. Multiple designs were emerging [3-7], but Neer's metal prosthesis became the most commonly used. In 1953, Neer [7] reported the first use of his prosthetic humeral head in a complex fracture-dislocation of the proximal humerus. In 1955 and 1970, he reported his series of 27 and 43 patients, respectively, with fracture-dislocations treated with prosthetic replacement [7,8].Advances in design since Neer's first-generation monoblock prosthesis and his subsequent redesign in 1973 have included the use of modular head and stem components. Restoration of soft tissue ten-

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Orthopaedic surgery

Moll¹

1983

Management of Rheumatic Disorders

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Fracture of the neck of the humerus with dislocation of the head fragment

Cited by 134 publications

References 3 publications

The Classic: Articular Replacement for the Humeral Head

The Classic: Articular Replacement for the Humeral Head

Arthroplasty for Proximal Humerus Fractures, Nonunions, and Malunions

Orthopaedic surgery

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