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PubMed1992

[Classification of fractures and problems in proximal humeral fractures].

Complex fractures of the proximal humerus may be difficult to assess and treat. Open or closed reduction and fixation may lead to malunion, nonunion, and/or avascular necrosis. Conversely, hemiarthroplasty also does not always result in satisfactory functional results. Various classifications have been established to compare the results of treatment and assist in decision making. The most commonly used classifications are those of Neer and the AO/ASIF group both of which appear to overestimate the relevance of avascular necrosis and underestimate the relevance of malunion. Because of the inter- and intraobserver variability in classifying these fractures, there is the potential for a wide variety of treatment recommendations, and predicting the prognosis becomes less accurate. Further work should be done in standardizing the classifications of proximal humerus fractures and defining the necessary X-ray projections.

Fracture Fixation, Internal↗
PubMed1991

[Fractures of the humeral head. Conservative and surgical differential therapy].

The Neer classification for fractures of the proximal humerus is a system based on accurate identification of the four major fragments and their relationship to each other. There is a specific type of displaced 4-fragment fracture of the proximal humerus which consists in valgus impaction of the head fragment. This type of fracture is combined with a lower rate of avascular necrosis than that of other displaced 4-fragment fractures. In addition, the outcome is different according to whether a displaced 4-fragment fracture affects the surgical or the anatomical neck. Those through the surgical neck have a much lower rate of avascular necrosis than those through the anatomical neck. Therefore, 4-fragment valgus impacted fractures through the surgical neck should be treated by open reduction and internal fixation rather than by primary hemiarthroplasty in younger patients.

Adult↗
PubMed1990

Fractures of the humerus.

Early active mobilization of sporting injuries is usually necessary for good functional results. Stable fixation, especially in severe joint fractures, should therefore be achieved. Indications according to the different fracture types using the AO-Classification and the fixation techniques, are described for proximal, shaft and distal humeral fractures.

Athletic Injuries↗
PubMed1993

Acute prosthetic replacement for severe fractures of the proximal humerus.

Nineteen patients with 20 severe proximal humeral fractures were treated early with a Neer humeral prosthesis from 1979 to 1986. There were 18 four-part and two three-part fractures. The average age of the patients at the time of injury was 64 years. Follow-up evaluation was performed at an average of 40 months. Pain relief was satisfactory in 18 of 20 fractures. Patients were satisfied with the result in 16 of the 20 shoulders. Functional evaluation was good or fair in 15 of 20 patients. Active forward elevation averaged 72 degrees and active external rotation 16 degrees. Complications consisted of one axillary nerve palsy, one postoperative posterior dislocation, loosening of one uncemented humeral prosthesis, and one breakage of fixation wire requiring subsequent removal. Patients who could not comply with the postoperative rehabilitation program had poor results. Poor function appeared to be directly related to lack of rotator cuff integrity. Surgical techniques designed to securing tuberosity union are essential.

Activities of Daily Living↗
PubMed1993

[Osteosynthesis of subcapital humerus fracture with unconventionally applied implants].

The osteosynthesis of proximal humerus fractures with the commonly used plates is often critical because of the small space subacromial, the irritation of the blood supply by the broad plates and the poor proximal anchorage without angle stability. The osteosynthesis with a children hip plate or a angle plate like modified DC-plate is thought to be a reliable alternative.

Adult↗
PubMed2006

Painless reduction of acute anterior shoulder dislocations without anesthesia.

In 1938, Dr Henry Milch described a maneuver for the reduction of acute anterior shoulder dislocations consisting of shoulder abduction and external rotation with "pulsion" of the humeral head. Although many methods may be used to reduce the dislocated glenohumeral joint, the Milch technique is unique because of its gentle, effective, and relatively painless nature. This article studied the effectiveness of this technique on 76 consecutive acute anterior shoulder dislocations in 75 patients seen in our institution's two campuses over an 18-month period. Twelve shoulders had concomitant fractures of the greater tuberosity. All 76 shoulders were reduced on the first attempt. No anesthesia was used, and no complications were reported from the reduction maneuver. The Milch method is an ideal first line treatment for all acute anterior shoulder dislocations including those associated with fracture of the greater tuberosity.

Adult↗