Rockwood and greens fractures in adults ed 3, philadelphia, pa jb lippincott, 1991, vol. Current concepts in locking plate fixation of proximal. The most common location of proximal fractures is at the surgical neck of the humerus. Periprosthetic fracture is an uncommon complication post arthroplasty, 54 although it is increasing in frequency. The neer classification of proximal humerus fractures is the most commonly used classification system. If one structure is angulated or displaced, the fracture has 2 parts see figure one and 2part fractures of the proximal humerus. The proximal humeral locking plate seems to be an adequate device for the fixation of displaced proximal humerus fractures as 83% of our study population had goodmoderate functional. Although this case does not perfectly fit into headsplitting or impaction fracture categories, the fracture clearly involves a significant portion of the articular surface. Evaluation and classification of proximal humeral fractures.
Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Humerus fractures functional union acceptable deformity. Find powerpoint presentations and slides using the power of, find free presentations research about proximal humerus fracture ppt. Jul 29, 2011 proximal humeral fractures phfs comprise 5% of all fractures in adults and are the third most common fracture in adults over 65 years old. The purpose of this study is to evaluate whether interobserver agreement can be improved with the application of. The brachial artery may be lacerated by the proximal fracture fragment, either at the time of injury or during reduction, and a compartment syndrome may develop. Symptoms include pain, swelling, and a decreased ability to move the shoulder. Proximal humerus fracture is quite a common injury among elderly population who are suffering with osteoporosis. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. Treatment depends on the type of fracture you have. The lectures have been compressed, for ease of download.
This clinical pathway aims to assist ed physicians, gps and orthopaedic surgeons manage pediatric proximal humerus fractures that present acutely. Free download shoulder and humerus fractures and dislocations. Coaptation splint temporary to provide initial comfort and. Proximal humerus fractures taiz university,faculty of medicine and health sciences by dr. At most major medical centers, orthopaedic grand rounds are lectures given by.
Initial portable anteroposterior xray image reveals humeral head displacement. Proximal humeral fractures msd manual professional edition. Additional notes and information are provided by many authors in the meeting notes section of. Periprosthetic fracture an overview sciencedirect topics. Humeral fractures are seen after both high and lowenergy trauma and are particularly characteristic of falls in elderly women with osteoporosis 8. Potential advantages of this approach include the easier exposure of the greater tuberosity and the limited surgical dissection around the fracture site. Sep 25, 2017 especially in fractures with medial comminution, the following principles have become important in order to increase the stability of locking plate fixation of proximal humerus fractures. A 5year prospective study of 1,027 people reported.
Proximal humerus fracturesdislocations powerpoint ppt presentation. Proximal humerus fracture includes the fracture of shaft of the humerus and greater tuberosity. Axial and coronal ct images better delineate an essentially shattered proximal humerus. There are three main contributions to the vascular supply of the humeral head. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. A proximal humerus fracture is a break of the upper part of the bone of the arm. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. Proximal humerus fracture book twin cities orthopedics. This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Successful treatment of fractures of the proximal humerus ie, that portion involving the glenohumeral articulation presents a challenge for. In 1970, charles neer ii created a classification system for fractures of the proximal humerus, which is widely utilized 2, 3.
Fractures of the proximal humerus are common, accounting for 5% of all fractures. Bone fractures and their types powerpoint presentation. Mri is not typically indicated in the setting of proximal humerus fracture, although it may be useful in assessing injury to soft tissue structures such as the rotator cuff muscles. Eightyeight patients aged 60 years or older with displaced more than 1 cm or 45 degrees 2part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1. By jack kazanjian, do, faoao, clinical assistant professor of orthopaedic surgery, pcom from the 9th annual philadelphia orthopaedic trauma symposium june 9. The majority of these fractures are the result of low energy falls, are minimally displaced, and may be treated with sling immobilization and physical therapy. The proximal fragment is abducted and shortening occurs at fracture site due to pull of biceps.
Nov 17, 2019 a proximal humerus fracture is a common injury to the shoulder. Listing a study does not mean it has been evaluated by the u. Conservative treatment, plate fixation, or prosthesis for. Ppt fractures of the humeral shaft powerpoint presentation. Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older. Aug 02, 2011 proximal humeral fractures account for nearly 5% of all fractures and are the third most common fracture after hip fractures and distal radial fractures. A proximal humeral upper arm bone fracture is a break in the upper aspect of the humerus, close to the ball and socket glenohumeral joint of the shoulder. Proximal humerus fractures phf are common injuries, but previous studies have documented poor interobserver reliability in fracture classification. Background and purpose when nonoperative treatment of proximal. Fracture distal humerus in adults authorstream presentation. These segments correspond to the four ossification centers of the proximal humerus. Especially in fractures with medial comminution, the following principles have become important in order to increase the stability of locking plate fixation of proximal humerus fractures.
Proximal humeral fractures may present with many different configurations in patients with varying comorbities and expectations. Proximal humerus fractures are common orthopaedic injuries that usually occur as a result from a direct blow to the shoulder, either in a fall or as the result of a highenergy trauma. I think most would define successful fracture treatment as a functional union with minimal deformity. These fractures tend to occur in older patients who are osteoporotic. Fractures ppt free download as powerpoint presentation. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Proximal humeral fracturedislocation with axillary artery. The shaft of the humerus connects with the proximal humerus at the. Physiologically induced motion at the fracture site favors healing of the fracture. Example of a fracture distal to deltoid tuberosity.
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. This increase has been attributed in part to the increasing frequency of revision arthroplasty poorer bone stock and the popularity of uncemented prostheses tight press fit required for ingrowth. A humerus fracture is a break of the humerus bone in the upper arm. Current concepts in treatment of proximal humerus fractures. Ppt fractures of the humeral shaft powerpoint presentation free to download id. Incidence of proximal fractures increases with age, with about 75% of cases occurring among people over the age of 60.
He subdivided the proximal humerus into four major areas. Powerpoint tips and tricks for business presentations. Proximal humerus fractures randomized control trial full. Learn the epidemiology of proximal humeral fractures. They usually can be treated conservatively with immobilization but more complex fracture patterns often require operative treatment. In this age group, about three times as many women than men experience a proximal fracture.
In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone after hip fractures and wrist. The arcuate artery, an interosseous vessel that is the terminal branch of the anterior humeral circumflex, is the main arterial contribution to the humeral proximal humerus fractures in the elderly. Ppt proximal humerus fractures powerpoint presentation. Classfication of proximal humeral fractures first systems dating back to 17th century, classed them as simple closed versus open 1896 kocher focused on the location of the fracture and divided proximal humerus fractures into supra tubercular, peritubercular, infratubercular, and subtubercular in 1934 codman described proximal. Distal humerus fractures orthopaedic trauma association. In fact, in patients older than 65, proximal humerus fractures are the third most common broken bone after hip fractures and wrist fractures. View and download powerpoint presentations on proximal humerus fracture ppt. Proximal humerus fracture is also one of the common injuries in athletes who participate in contact sports. Prev view hires image download powerpoint slide next. Proximal humerus fracture is the third most common fracture type after hip and distal radius fracture in elderly patients. Proximal humerus fractures account for 6% of all fractures in the western world. Feb 03, 2020 how is a proximal humerus fracture diagnosed. There is also an impaction fracture of the glenoid.
Should this trend continue, the fracture rate would triple over the next three decades. There may be a decreased ability to move the arm and the person may present holding their elbow. Understanding the functional anatomy of the proximal humerus as it relates to fracture is paramount to achieving these goals. Proximal means it is the end of the bone that is closest to the body. The typical presentation of a proximal humerus fracture is an elderly female who falls and sustains a minimally displaced or 2part fracture. The proximal humerus is composed of four distinct anatomic segments. You may need more than 1 xray, or another xray after several days have passed. Re fractures of the shaft of the humerus in rockwood ca jr. This disparity has been attributed to multiple variables including poor imaging studies and inadequate surgeon experience. Neer classification of proximal humeral fractures radiology. Current concepts in classification, treatment and outcomes. Minimally invasive plate osteosynthesis for proximal. Find powerpoint presentations and slides using the power of, find free presentations research about fracture proximal humerus ppt. Treatment should focus on maximizing a patients functional outcome and minimizing pain.
View and download powerpoint presentations on fracture proximal humerus ppt. Especially common in elderly individuals due to osteoporosis, proximal humerus fractures are among the most common broken bones in the shoulder. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Fractures of the proximal humerus are among the most common fractures of the appendicular skeleton, representing approximately 5. Provide sickkids parent information sheet proximal humerus fracture activities that may result in reinjuring the shoulder should be avoided for approximately 12 weeks from the date of injury girl over 10 years old with. Capitellar and trochlear fractures type i these are isolated capitellar fractures involving a large portion of cancellous bone. Evaluation and management of proximal humerus fractures. To view power point presentations for download, click here. Operative versus nonoperative treatment for 2part proximal. Almost 80% of proximal humeral fractures have only one part. The crux of this system is based around the bony anatomy of the proximal humerus defined by codman in the 1930s. The most common mechanism for these fractures is a fall on the outstretched hand from a standing height.
Proximal humerus fractures phfs are common, particularly among older adults, and account. Your healthcare provider will ask about your injury and examine you. Upper extremity orthopaedic trauma association ota. Ppt proximal humerus fracturesdislocations powerpoint. Proximal humerus shoulder fractures musculoskeletal. Proximal humerus fractures are commonly encountered fractures in general orthopaedic practices. Proximal humerus fractures randomized control trial the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A proximal humerus fracture is a common injury to the shoulder. Proximal humerus fractures a free powerpoint ppt presentation displayed as a flash slide show on id.
Classification and treatment of proximal humerus fractures. Jun 28, 2017 by jack kazanjian, do, faoao, clinical assistant professor of orthopaedic surgery, pcom from the 9th annual philadelphia orthopaedic trauma symposium june 9, 2017, lewis katz school of medicine at. The neer classification of proximal humeral fractures is probably the most frequently used system along with the ao classification of proximal humeral fractures. Evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and costeffectiveness of surgical compared with nonsurgical treatment for proximal fracture of the humerus in adults. The aim of this study was to evaluate the clinical and radiographic results after minimally invasive plate osteosynthesis mipo for proximal humerus fractures. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patientrelated factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Ppt proximal humerus fractures powerpoint presentation free to.