Abstract
Head-split 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. The articular surface is fragmented into disconnected pieces, frequently these fractures often very challenging and demanding in terms of initial diagnosis and treatment options. They often need surgical intervention because of their articular fracture pattern and their high risk of malunion with the development of premature glenohumeral arthritis. Moreover, head-split fractures are often misdiagnosed on initial plain radiographs, which can delay and complicate appropriate treatment. The purpose of this article is to provide an overview of the diagnosis, classification, and treatment of head-split fractures.
Highlights
Proximal humerus fractures account for approximately 6% of all fractures [1]
While improvement of surgical techniques and fixation devices may allow for adequate fragment reduction and retention, ischemia leading to avascular necrosis (AVN) of single or multiple fragments of the humeral head remains a concern in the treatment of head-split fractures or complex proximal humerus fractures in general
Owing to the difficulty of exactly determining the extent of damage to the vascular blood supply of the head fragments and the existing chance of revascularization, joint-preserving treatment is recommended in young patients regardless of the complexity of the proximal humerus fractures including head-split fractures as long as acceptable reduction and sufficient stabilization of the fragments can be achieved [3]
Summary
Proximal humerus fractures account for approximately 6% of all fractures [1]. Several different types of proximal humerus fracture patterns with varying treatment options exist. If the pelican sign is detected on axillary views, a type II head-split fracture is diagnosed.
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