The multiloc proximal humeral nail is indicated for fractures of the proximal humerus, including. Proximal humerus fracture with glenohumeral dislocation. Apr 26, 2017 humeral head fractures requiring surgical intervention are severe injuries, which might affect the return to sports and daily activities. Hemiarthroplasty for headsplit fractures of the proximal humerus.
Humerus fracture upper arm fracture johns hopkins medicine. It remains a good option in comminuted 3part fractures especially in elderly patients with poor bone quality or a high degree of comminution bigliani 1990. Return to sports after plate fixation of humeral head. We hypothesize that athletic patients will be constrained regarding their sporting activities after surgically treated humeral head fractures. Proximal humerus fracture classifications shoulderdoc by. Ten suture holes around the perimeter of the proximal end distal shaft of standard plate consists of three or. Review article surgical treatment of displaced greater tuberosity fractures of the humerus abstract. There are several types of humerus fractures, depending on the location of the break. The humerus is the arm bone between your shoulder and your elbow. Pdf proximal humerus headsplitting fracture associated with. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. Sep 02, 20 the incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Hemiarthroplasty for headsplit fractures of the proximal. The head is the part of the arm that inserts into the shoulder socket.
The humerus is the long bone in your upper arm that connects your shoulder joint to your elbow joint. Head splitting can also occur as a part of complex proximal. Shoulder hemiarthroplasty in proximal humerus fractures. Fractures involving the attachments of the rotator cuff. International healthcare awards 2018 winner among best physiotherapist in jammu dr. Does tenodesis of the long head of the biceps improve results. Proximal humerus fracture includes the fracture of shaft of the humerus and greater tuberosity. One of the most common bone fractures people can sustain is at the neck of the humerus. Most of these injuries can be treated without surgery with a good, longterm. This incision is placed between the acromial part 2 and the spinal part 3 of the deltoid muscle, as illustrated. Part of the depuy synthes locking compression plate lcp 3. Locked plate osteosynthesis of humeral headsplitting fractures in.
While the treatment of proximal humerus fractures remains controversial, certain fractures benefit from plate fixation such as fracture dislocations and head split fractures. An olecranon osteotomy provides a wide exposure, particularly of the dorsal two thirds of the distal humerus which is sufficient for most of the intraarticular fractures. Most humeral heads have a diameter between 4 and 5 cm, and the head. Isolated humeral head splitting fractures are rare injuries. A particular fracture pattern is the socalled head split fracture, which is rarely encountered but represents a serious treatment challenge because of the involvement and occasionally the comminution of the articular surface.
Headsplit fractures of the proximal humerus are rare fractures that usually require hemiarthroplasty due to a high incidence of osteonecrosis. Headsplit fractures account for less than 5% of proximal humerus fractures and occur when the humeral head cleaves as it impacts against the narrow anvil of the glenoid into two or more large fragments, generally associated with fractures of the tuberosities or surgical neck. To the best of our knowledge, there have been few published cases of proximal humerus head splitting fracture associated with anterior dislocation of the split part, as described in this case trapped between the anterior glenoid and the subscapularis. Fractures which split the humeral head are extremely rare, and are usually caused by a direct fall on to the shoulder with impaction of the head against the glenoid. Review article surgical treatment of displaced greater. Head splitting fractures occur as a result of violent compression of the head against the glenoid. Multipart headsplitting proximal humerus fractures can result in a high incidence of avascular necrosis. There is a consensus among orthopaedic surgeons that elderly patients who present with a head split after a proximal humerus fracture will require either reverse shoulder replacement or hemiarthroplasty. Favorable results with osteosynthesis can be difficult to achieve because of the very proximal location of the head fracture and associated. The arm is made up of many different parts, even at the level of the humerus. Amresh jamwal shows easy exercises which you should do following fracture of humerus. Trauma from a fall or accident are often the cause of this type of fracture. A break in the humerus bone occurs in one of three general locations.
They usually result from trauma in individuals this age. Proximal humerus fracture proximal humerus fracture. Displaced and unstable two to fourpart fractures of the proximal humerus. A humerus fracture is a break in the large bone of your upper arm. This is when the proximal humerus is fractured, and the joint surface of the ball humeral head and socket glenoid are out of their normal alignment. Fulltext pdf selected anteromedial coronoid fractures can be treated nonoperatively.
Internal fixation of fractures of the proximal humerus with. Trauma, such as a fall or highimpact injury, is the major cause of most shoulder fractures. Head splitting can also occur as a part of complex proximal humerus fractures seen in highvelocity injuries in younger. There may be a decreased ability to move the arm and the person may present holding their elbow. Threepart headsplitting proximal humerus fracture through a. Fractures that split the humeral head are extremely rare, and usually, the split part is posteriorly dislocated. Exercises following fracture of humerus upper arm youtube. There are two types of humerus fractures based on the location of the breaks. Nearly half of depression fractures 46% occur following anterior glenohumeral.
Proximal humerus headsplitting fracture associated. Evaluation and management of proximal humerus fractures. Partial osteonecrosis of the humeral head developed in one patient. Gartlands classification of supracondylar fracture of humerus.
Headsplit fractures account for less than 5% of proximal humerus fractures and occur when the humeral head cleaves as it impacts against the. Select the size of the humeral head template that most closely matches the diameter of the patients humeral head. Bony healing occurs usually within 6 to 8 weeks in adults 3. Shoulder, humerus head fracture, sports injury, return to sports after fracture. Regarding the treatment decisionmaking process, a literature scan revealed the lack of information about the treatment of humeral head splitting fractures. Proximal humerus, humeral shaft, and distal humerus fractures are all common adult fractures, and often occur in older patients. Mar 02, 2017 one of the most common bone fractures people can sustain is at the neck of the humerus. Pdf headsplit fractures of the proximal humerusheadsplit. Proximal humeral fractures treated with hemiarthroplasty. Of these, the proximal humerus locking plate is the most widely used. Headsplitting and impression fractures are usually the result of a severe impaction of the humeral head into the glenoid, with or without dislocation. Thus, if open reduction and internal fixation is indicated, reconstruction of the proximal humerus should be performed within 5 days of the fracture event.
Locked plate osteosynthesis of humeral headsplitting. Fractures of the proximal humerus extending in the humeral. Around the world, this type of fracture remains a major challenge for treating surgeons. Neer 4 part or ao ctype fractures and fracture dislocations. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. While nondisplaced fractures can be managed conservatively, displaced ones are often treated surgically. Complex headsplitting fracturedislocation of the proximal. Thus, there is less mechanical stress applied to the humeral head as it heals.
Exposure of the fracture using an anterior acromial approach and determination of the correct nail entrance point. The neer classification of proximal humeral fractures is probably the most frequently used system along with the ao classification of proximal humeral fractures. Complications may include injury to an artery or nerve, and compartment syndrome. Proximal humerus headsplitting fracture associated with. Proximal humerus fracture surgery, like all types of surgery, carries some risks, such as infection. It is especially useful for osteosynthesis of fractures of the greater tuberosity. Fractures which split the head were not included in the initial classi. Swordlike trauma to the shoulder with open headsplitting. Pdf headsplit fractures account for less than 5% of proximal humerus fractures and occur when the humeral head cleaves as it impacts against the. The transdeltoid lateral approach can be used for various treatments of the proximal humeral fractures. The humeral head fragment has a wider fracture surface relative to the thickness of the head. Headsplit fractures of the proximal humerus springerlink.
Osteosynthesis with a precontoured fixed angle plate was performed in all patients. Jun 01, 2012 they usually result from trauma in individuals this age. Headsplit fractures account for less than 5% of proximal humerus fractures and occur when the humeral head cleaves as it impacts against the narrow anvil of the glenoid into two or more. Restoration of a stable boneimplant construct that enables early functional aftertreatment.
However, in our case, the split part was anteriorly dislocated and trapped between the anterior glenoid and the subscapularis muscle. Proximal humerus fracture is also one of the common injuries in athletes who participate in contact sports. Apr 30, 2014 humeral head split in the elderly is shoulder prosthetic replacement always necessary. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Proximal humerus fracture book twin cities orthopedics.
Nonoperative proximal humeral fracture rehabilitation protocol general principles. C fractures, provided that the domed head fragment is large enough and that it is not itself fractured. Preexisting severe osteoarthritis of the shoulder joint. The osteotomy however adds another fracture that needs fixa. Jul 01, 20 however, headsplit fractures are rare, and, to the authors knowledge, this study is the first to focus on the outcomes of hemiarthroplasty for headsplit fractures of the proximal humerus. Timing of surgery for open reduction and internal fixation of. Proximal humeral fractures with a severe varus deformity.
Proximal humerus fracture is quite a common injury among elderly population who are suffering with osteoporosis. Soliman oa, koptan wmt injury 20 rct with 37 patients treated with hhr for 4part fractures, fracture dislocations, and head split fractures lhb intact in 18 group 1 tenodesis in 19 patients group 2 constant score. Surgery is usually needed to reduce the dislocated fragment, which is now devoid of capsular and tendinous attachments. When trying to decide between two sizes, the smaller. Despite a long rehabilitation program physical activities will change and an avoidance of overhead activities will. In head split and dislocated fracture types anatomic reconstruction completed within 48h from the incident may be beneficial with regards to risk of avascular necrosis. Pdf fractures involving splitting of the humeral head. Anatomical reduction of two to fourpart fractures of the proximal humerus. Fracture of the neck of the humerus the law offices of. Radiographic evaluation xray 4 views ap, grashey, scapular y outlet, axillary xray cannot truly rule out a dislocation without an axillary view xray many times all that is needed initially based on exam and complaints mri nonarthrogram evaluate rotator cuff arthrogram evaluate labrum iv contrast masses or cysts.
When glenohumeral dislocation accompanies fracture of the proximal humerus, the articular head fragment tends to be displaced into the axilla. Injury can cause the humerus ball or the glenoid socket of the shoulder joint to break fracture. Treatment varies depending on the type and severity of the break but may. If a fracture or fracture repair is stable, then therapy should be started early. Sep 28, 2012 anatomical reduction of two to fourpart fractures of the proximal humerus using indirect reduction techniques. This is an enhanced pdf from the journal of bone and joint surgery. Headsplitting and impression fractures are usually the result of a severe impaction of the humeral head into the glenoid, with or without.
Subsequent remodelling was enhanced by early mobilisation. Head split fractures of the humerus head that cannot be reduced. Pdf headsplit fractures of the proximal humerushead. Estimate the size of the humeral head overlay the humeral head template on the radiograph of the fracture and compare it to the humeral head size from the opposite side. Results the mean preoperative head shaft inclination angle. The treatment of proximal humeral fracture in adults. The most useful rehabilitation protocol is the threephase system. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function.
Fractures were subclassified as simple fracture line splitting the humeral head without associated tuberosity fractures and complex split humeral head with tuberosity fractures. Clinical, radiographic, and objective outcomes of the headsplit fractures were collected at a minimum of 12 months followup and compared with a control group of 22 three and 4part fractures. Several different types of proximal humerus fracture patterns with varying treatment options exist. Expert humeral nail and expert proximal humeral nail. Fractures involving splitting of the humeral head semantic scholar. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Humeral head split in the elderly is shoulder prosthetic replacement always necessary. Neer classification of proximal humeral fractures radiology. Head splitting fractures are a further development of this mode of injury, as the humeral head is cleaved into at least 2 separate fragments. The purpose of this study was to report the outcomes after humeral head replacement and the radiographic characteristics identified in head split fractures. Other words often used to describe a proximal humerus fracture are. A humerus fracture is a break of the humerus bone in the upper arm. Plate fixation for management of humerus fractures. Humeral head split fractures, in which a portion of the humeral head breaks and disrupts the cartilage of the joint.