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Proximal humerus fractures with valgus deformity of the humeral head: The spectrum of injury, clinical assessment and treatment

2010; Elsevier BV; Volume: 19; Issue: 7 Linguagem: Inglês

10.1016/j.jse.2010.06.002

1532-6500

C. M. Robinson, David Longino, Iain R. Murray, Andrew D. Duckworth,

Trauma Management and Diagnosis

Fractures of the proximal humerus, in which the head is displaced into a valgus position, have been distinguished from other 3- and 4-part fractures by their unique anatomic configuration, which may favor fracture union and reduce the risk of osteonecrosis. Anatomically, this pattern is recognized by the valgus orientation of the humeral head, which is fractured and driven into the proximal metaphysis of the shaft by axial loading, subsequently producing secondary tuberosity fractures (Figure 1). This injury pattern was not specifically described amongst the other 3- and 4-part fractures in the classification popularized by Neer. 34 Neer C.S. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52: 1077-1089 Crossref PubMed Google Scholar Although its anatomic features have been subsequently described, 13 Duparc J. Largier A. [Fracture-dislocations of the upper end of the humerus]. Rev Chir Orthop Reparatrice Appar Mot. 1976; 62: 91-110 PubMed Google Scholar , 50 Stableforth P.G. Four-part fractures of the neck of the humerus. J Bone Joint Surg Br. 1984; 66: 104-108 PubMed Google Scholar Jakob et al was the first to formally recognize its more benign prognosis. 25 Jakob R.P. Miniaci A. Anson P.S. Jaberg H. Osterwalder A. Ganz R. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br. 1991; 73: 295-298 PubMed Google Scholar