Muller in 1991, proposed another widely used classification method, the AO classification which has been updated with the OTA association in 2007. This classification is not correlated with the extent to which the humeral blood supply may be affected following a fracture. At times even with sophisticated imaging techniques, it may be difficult to access the fracture pattern at first presentation. Each of these fractures, whether displaced or undisplaced can be accompanied by an anterior or posterior gleno-humeral joint dislocation, however this has been shown to be associated with a low rate of inter and intra observer reliability. Depending on the number of fracture lines present, the fracture can be subdivided into two, three or four part fractures. Despite the common reference to Neer that 85% of all proximal humeral fractures are undisplaced, a recent prospective study showed that the figure could be closer to around 50%. A considerable number of proximal humeral fractures are undisplaced fractures. one-part fracture according to Neer’s method. Therefore, a fractured lesser tuberosity that does not meet the above criteria, is classified as an undisplaced fracture i.e. Neer argued that these parts can be affected by fracture lines, however, will be considered as a significant displacement if the segment has moved more than 10mm, or is at an angle of 45 degrees or more in relation to the rest of the segments or the humerus. The proximal humerus subdivided into four segments 1) the humeral head superior to the anatomical neck 2) greater tuberosity 3) lesser tuberosity 4) humeral shaft. The essence of this method of classification is based on the anatomical concepts described by Codman in the 1930s. Ĭharles Neer’s classification of the proximal humeral fractures in 1970 is the most widely used system for classifying these fractures. It has been reported that about a fifth of all proximal humerus fractures require a surgical intervention.
CLOSED FRACTURE OF PROXIMAL END OF RIGHT HUMERUS SKIN
The majority of proximal humeral fractures are closed fractures meaning thatthere is no laceration of the overlying skin by the fracture of humerus. In fact, a study of the Finish population by Palvanen, showed that the incidence of proximal humeral fractures related to osteoporosis had tripled in number between 19. Patients with poor bone quality and osteoporosis are those at highest risk of sustaining this type of fracture. These fractures are about 3 times more common in women than men and the majority (about 90%) are as a result of falls from standing height. The prevalence is highest in the elderly population and the incidence rises markedly with age, with highest prevalence in those aged 70 years and over. Today, proximal humeral fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults. In the 19 th and 20 th century, notable advances were made in the management of these fractures with the introduction of sophisticated splinting techniques and internal fixation for displaced fractures. For many centuries the mainstay of treatment in these fractures had been the Hippocratic doctrine: forceful reduction and bandaging followed by splinting (1). Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3 rd century BC (1). This systematic review of literature compares the surgical treatment of proximal humeral fractures with their conservative management, by evaluating the available randomised controlled trials on this topic. Furthermore, there is a lack of consistency in the definitive treatment and management of displaced fractures. With the rising incidence of proximal humeral fractures, especially among the elderly, the short and long term burden for patients as well as the wider society is increasing. Failure to achieve this can result in impairment of function, and significantly weaken the muscles inserting onto the proximal humerus. The aim of treatment is to stabilize the fracture, aid better union and reduce pain during the healing process. In broad terms the management of proximal humeral fractures can be divided into two categories: conservative versus surgical intervention.
Today, these fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults with the incidence rising rapidly with age. Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3rd century BC.
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