Abstract
Proximal humeral fractures are extremely common injuries, and are one of the true osteoporotic fractures. Most fractures can be effectively treated nonoperatively, as the rich vascularity and broad cancellous surfaces impart a high propensity for healing. Additionally, many fracture patterns result in adequate bone contact and minimal displacement with acceptable alignment. Open reduction and internal fixation of displaced fractures can improve outcomes, depending on the pre-injury functional status of the patient. If operative treatment is selected, unique treatment challenges must be overcome, including obtaining and maintaining reduction of small bone fragments with strong muscle forces, often in osteoporotic bone. Many options are feasible, including plates, nails, sutures, and other novel devices. Locking plates are the most common device used, but technical detail is critical to minimize the risk of implant failure, loss of reduction, and reoperation.
Highlights
Proximal humerus fractures are seen most commonly in the elderly population, following a low energy fall [1, 2]
The initial evaluation of a patient suspected of having sustained a proximal humerus fracture should begin with a proper history and physical examination
A thorough understanding of the anatomy is needed, as cadaveric studies have shown that the axillary nerve, cephalic vein, biceps tendon, and posterior humeral circumflex artery are all at risk with this technique [32, 33]. As this technique has a steep learning curve, a limited open technique to assist in reduction and wire placement may be warranted. This technique has been described as a method to treat proximal humerus fractures and avoid the complications associated with implant placement and arthroplasty [34, 35]
Summary
Proximal humerus fractures are seen most commonly in the elderly population, following a low energy fall [1, 2]. The initial evaluation of a patient suspected of having sustained a proximal humerus fracture should begin with a proper history and physical examination. The initial shoulder series is taken with the patient in the supine position This allows the arm to extend relative to the humeral head and may accentuate the deformity on the axillary view. After a complete history and physical examination, a standard shoulder radiograph series of the affected shoulder, as well as any other suspected injuries, should be obtained. This consists of a true anterior-posterior (AP) view of the glenohumeral joint, a scapular-Y, and an axillary view. Another option is the Velpeau view, which allows the radiology technician to obtain an axillary view with the patient in a sling [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
