Humeral neck fracture7/24/2023 ![]() PROFHER Trial: in patients with displaced fractures involving the surgical neck, no significant difference in clinical outcome in patients treated operatively versus non-operatively ( Handoll 2015).However, in the literature, no clear benefit has been found. The use of operative treatment in displaced fractures is increasing, due to concern for improved functional outcome.Complications: malunion, subacromial impingement, osteoarthritis and rotator cuff deficiency.Non-operative management typically considered in elderly patients with minimal functional demands, patients not fit for surgery.Displaced fractures: Orthopedic consultation for evaluation and operative planning.Active range of motion exercises of wrist and hand within 2 weeks of injury.Early Range of Motion exercise: decreases the risk of developing adhesive capsulitis.Close Orthopedic follow-up to confirm acceptable alignment and fracture stability.Immobilization with a cuff, sling or shoulder immobilizer.85% of proximal humerus fractures ( Quillen 2004).Nondisplaced or minimally displaced fractures.C3: Anatomic neck fracture with glenohumeral dislocation.C2: Anatomic neck fracture with marked displacement.C1: Anatomic neck fracture with slight displacement.Type C: articular fracture, involving either the humeral head or anatomic neck, most severe, highest AVN risk.B3: surgical neck fracture with a displaced fracture of either the greater or the lesser tuberosity and glenohumeral dislocation.B2: nonimpacted surgical neck fracture with a displaced fracture of either the greater or lesser tuberosity.B1: surgical neck fracture with metaphyseal impaction and a displaced fracture of either the greater or lesser tuberosity. ![]() Type B: extra-articular, bifocal, associate with two fracture lines, higher AVN risk.A3: surgical neck fracture without metaphyseal impaction.A2: surgical neck fracture with metaphyseal impaction.Type A: extra-articular, unifocal, associated with a single fracture line, lowest avascular necrosis (AVN) risk.Each fracture type is further subgrouped according to displacement, valgus or varus angulation of the humeral head, comminution and the presence and direction of glenohumeral joint dislocation.Based on fracture location and the presence of impaction, angulation, translation, comminution, or dislocation.Proximal Humerus AO Classfication – AO/OTA Classification Unable to differentiate between the types of minimally displaced fractures.Definition of displacement arbitrarily defined by Neer at time of publication without evidentiary support.Low inter- and intra- observer reliability.Valgus Impacted Four-Part: head of humerus is rotated into valgus posture and driven down between the tuberosities.Four Part: All four segments (both tuberosities, the articular surface, and the humeral shaft) displaced.Three Part: Displacement of one tuberosity and the surgical neck.Two Part: One segment is displaced, either the greater tuberosity, the lesser tuberosity or humeral head.One Part: Nondisplaced fracture, irrespective of number of fragments.Displaced Fracture: fracture with greater than 1 cm of displacement and less than 45 degrees of angulation from anatomic position ( Carofino 2013).Based on four anatomical fracture segments:.Depends on number of fragments, degree of displacement and presence of dislocation.
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