In these scenarios, the herzog curve facilitates an easier entry portal attainment and nail insertion with an incision just medial to the rotator cuff insertion. It is therefore very important that the exercises listed. Nov 03, 2017 twopart surgical neck fracture of the proximal humerus with posteromedial communition fixation using a combination of and intramedullary cortical strut and plate. Surgical treatment for a proximal humerus fracture. Rehabilitate r esuscitate advanced trauma life support.
Treatment of the surgical neck fracture of the humerus. Group iii comprises three types of displaced twopart surgical neck fractures i. P roximal humerus fractures in the elderly are a relatively rare injury, and appropriate treatment, especially of displaced fractures, remains controversial. Management of displaced surgical neck fractures of the humerus. Surgical neck of humerus musculoskeletal, skeletal. Treatment for displaced fractures should consider the patients level of independence, bone quality, and surgical risk factors. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint. The long head of biceps runs between the tuberosities in the bicipital groove, and the surgical neck is just below the greater and lesser tuberosities. Around 50% to 65% of all proximal humerus fractures are minimally displaced fractures of the greater tuberosity andor surgical neck that respond well to nonoperative management. The incidence of proximal humerus fractures is 4% to 5% of 1all fractures. This is when the proximal humerus is broken into three pieces, and there are then two fracture lines on xray. The availability of new, specific implants spurs some on toward operative intervention, whilst some texts still recommend treatment techniques of questionable. There are a wide range of potentially suitable treatments for a fractured neck of humerus, which depend on the type of fracture and the activity level of the patient. Surgical neck of the humerus definition of surgical neck of.
The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. These types of humerus fractures are most often caused by direct trauma and is commonly sustained in car. Management fracture management stages include 4 rs. Surgical neck fractures occur in all age groups, affecting pediatric, young adult. Post fracture proximal humerus rehabilitation guidelines. Fragility fractures of the proximal humerus commonly occur at the metaphysis, or surgical neck, of the humerus and are impacted and minimally displaced. There may be a decreased ability to move the arm and the person may present holding their elbow. We treat this injury by putting your arm in a sling, or shoulder immobiliser, which keeps it at a right angle. Pdf proximal humerus fractures current treatment options. The humeral head articulates with the glenoid fossa of the scapula.
The majority of surgical neck of the proximal humerus fractures are nondisplaced or minimally displaced and do not require operative intervention. Non operative management minimally displaced surgical neck 1,2,3 greater tuberosity apr 23, 20. This is an enhanced pdf from the journal of bone and joint surgery. Recent surveys suggest shoulder arthroplasty and operative fixation are favored by a large number of surgeons over a range of fracture types in. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. Humerus fractures functional union acceptable deformity. Sep 19, 2014 surgical neck fractures are the most common type of proximal humeral fracture. These fractures tend to occur in older patients who are osteoporotic. Operative treatment of displaced surgical neck of humerus fractures. Humerus, distal end segment, complete, multifragmentary articular fracture, wedge or multifragmentary metaphyseal fracture c3 qualifications are optional and applied to the fracture code where the asterisk is located as a lowercase letter within rounded brackets. Return to normal function and motion may require 3 to 4 months overall goals. Neer classification of proximal humeral fractures radiology. This incidence is increasing, especially among younger age groups as they place higher demands on their shoulder joints as a result of high levels of activity.
A temporary splint extending from the shoulder to the forearm and holding the elbow bent at 90 degrees can be used for initial management of the fracture. Case report of a surgical neck humerus fracture due to. A fracture in this area can be very painful and make elbow motion difficult or impossible. Mar 02, 2017 a distal humerus fracture affects the elbow and is a break in the lower end of the humerus. Humerus fracture upper arm fracture johns hopkins medicine. The results of surgery may improve in future with the introduction of better techniques and the use of bonestrengthening agents, but currently we do not advocate the use of internal fixation to treat twopart fractures of the surgical neck of the proximal humerus regardless of the degree of initial displacement. Proximal humeral fracture post surgical rehabilitation protocol open reduction internal fixation general principles. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Many different options for osteosynthesis have been described. These cases with compound comminuted intercondylar fractures present a challenge to orthopaedic surgeons.
Jan 06, 2020 proximal humerus fracture is often seen in elderly population 1 and postmenopausal female. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact. There is an increase in incidence of high velocity injury to lower end of humerus. Fractured surgical neck of the humerus your humerus is the bone in your upper arm.
The aoasif fracture classification helps in guiding treatment. Typical appearances of a surgical neck of humerus fracture. Surgical neck fractures occur in all age groups, affecting pediatric, young adult, and geriatric individuals. This video highlights a clinical case where a midshaft humerus fracture was diagnosed and treated with open reduction internal fixation using an 8hole 4. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. Second most common upper extremity fracture in patients over age 65 more common in women. Operative versus nonoperative treatment for twopart surgical neck fractures of the proximal humerus. The surgical neck of the humerus is a constriction below the tubercles of the greater tubercle and lesser tubercle, and above the deltoid tuberosity. B, the depression type involves an inferiorly displaced and impacted greater tuberosity. If the bone cannot be surgically repaired, the ball of the shoulder may be replaced.
Most fractures can be treated nonoperatively, with a supportive sling for 3 to 6 weeks. You will see a shoulder specialist 3 weeks after your injury. If a fracture or fracture repair is stable, then therapy should be started early. The upper part of the humerus forms part of the shoulder joint and the lower part of the bone helps form part of the elbow joint. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Operative interventions for the management of proximal humerus fractures are. Reduce if displaced may be by open reduction, closed manipulation, or traction 3. Non displaced 2 part fracture good alignment does not involve an articular surface. This fracture is commonly seen in adult but in the rare case it may also happen to children. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf. In some cases, the broken proximal humerus must be surgically repaired or replaced. The treatment of proximal humeral fracture in adults. Surgical management of fracture humerus bmr medicine. Operative treatment of displaced surgical neck of humerus.
Treatment of unimpacted fractures of the surgical neck of the. It is a clinically important anatomical feature of the humerus as it is the most frequently fractured site of the proximal humerus, putting the axillary nerve and posterior circumflex humeral branch of the. Conquest hospital fracture clinic reception 01424 758104 eastbourne dgh fracture clinic reception 023 414981 hospital switchboard 0300 1 4500 this information leaflet explains the ongoing management of your injury. A break, or fracture, in the surgical neck of the humerus is quite common, especially among older women.
Review article surgical treatment of displaced greater. Keep the patient comfortable and minimise any need for movement. The fracture is in a good position and only has a small chance of moving. Treatment of the surgical neck fracture of the humerus with a. Management of displaced proximal humeral fractures. Indeed, many of these fractures are now successfully treated with immobilization in a sling. Most of these fractures in older patients can be treated nonoperatively in a sling. Sep 01, 2016 first, on the head neck of the humerus. Complications may include injury to an artery or nerve, and compartment syndrome. I think most would define successful fracture treatment as a functional union with minimal deformity. The main challenge in the operative treatment of displaced and unstable proximal humerus fractures is to achieve effective stabilization of an adequately.
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. C, the split type is a large fragment characterized by a vertical fracture line. There is a fracture through the surgical neck of the humerus. Treatment decision of displaced proximal humeral fractures is based on bone quality, fracture pattern, degree of displacement and patient profile. It is much more frequently fractured than the anatomical neck of the humerus. Phase i 0 21 days begin elbow, wrist and hand active rom. Surgical treatment of three and four part proximal humeral fractures. A fracture in this area is most likely to cause damage to the axillary nerve and posterior circumflex humeral artery. You will have another xray and they will assess your shoulder and guide the next stage of your rehabilitation. Neurovascular compromise from fracture requires emergent reduction andor orthopedic intervention. A proximal humerus fracture is typically categorised using the neer system which looks at the number of fracture parts and the level of displacement of these parts. Like the femur, the treatment of humerus fractures depends upon the fracture location and pattern. In this article we will cover the middle part, that is the shaft of the humerus bone. A humerus fracture is a break of the humerus bone in the upper arm.
Retain to maintain position while healing occurs by internal fixation, external fixation, or conservative methods 4. Sep 02, 20 fractures of the surgical neck of the humerus include the typical subcapital humeral fracture a twofragment fracture as well as most threefragment and all fourfragment fractures. In the test group, the fracture was firstly fixed with intersection pinning using 3 schanz pins 3. Treatment is often guided by displacement and angulation of fracture fragments. Models with the surgical neck twopart fracture of the proximal humerus were built, in which a novel external fixator test group and a clover plate control group were applied separately. Increase rom while protecting the fracture site you can be slightly more. Surgeons may use nails, plates, and screws to secure pieces of bone together. The neer classification of proximal humeral fractures is probably the most frequently used system along with the ao classification of proximal humeral fractures. Professor of clinical surgery assistant resident surgeon cincinnati, ohio in unimpacted fractures of the surgical discomfort to the patient. Pediatric proximal humerus fractures are a relatively common physeal and metaphyseal fracture of the proximal humerus seen in children with a peak age of 15 year of age.
A, the avulsion type involves a smaller fragment with a horizontal fracture line. Distal humerus fractures of the elbow orthoinfo aaos. Surgical neck of the humerus synonyms, surgical neck of the humerus pronunciation, surgical neck of the humerus translation, english dictionary definition of surgical neck of the humerus. Surgical treatment of three and fourpart proximal humeral fractures. Fractures of the proximal humerus are common, accounting for 5% of all fractures. These injuries typically require surgical fixation if displaced or angulated, whereas lessdisplaced fractures. A humerus shaft fracture may be treated with or without surgery, depending on the fracture pattern and associated injuries i. Patient education proximal humerus fractures explanation of diagnosis andor procedures shoulder anatomy the humerus is the long bone that connects the shoulder to the elbow. The fracture is also observed in children mostly following fall and young adults following direct impact, which results in fracture. Surgical neck fractures are the most common type of proximal humerus fractures. The chart showing pdf series, word series, html series, scan qr codes. Upper extremity fractures generally occur with a fall onto an outstretched arm.
A fractured neck of humerus is a common injury of the upper limb. Proximal humerus fractures current treatment options. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. The incidence of the surgical neck fractures of humerus is reported to be around 85% in people older than 50, with the peak incidence in the 60 to 90yearold agegroup with a female to male ratio of 70. The anatomical neck separates the greater and lesser tuberosities from the humeral head. The surgical neck of the humerus on the other hand is a constriction of the humerus located inferior to the greater and lesser tubercles. Another area we see 2part fractures is the surgical neck of the humerus. Bony healing occurs usually within 6 to 8 weeks in adults 2. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. Isometric, pendulum, or passive range of motion exercises should be started. Just because you see a fracture of the surgical neck of the humerus doesnt meed it needs surgery.
The most common mechanism for these fractures is a fall on the outstretched hand from a standing height. Health related quality of life, functional and radiographic results article pdf available in injury 43 suppl 2. Apr 05, 2016 hauschild o, konrad g, audige l, et al. Proximal humerus fracture book twin cities orthopedics. The most useful rehabilitation protocol is the threephase system. Open fractures require immediate iv antibiotics and urgent surgical washout. The full text of this article is available in pdf format. Sixtyfive patients who underwent repair of a three or fourpart proximal humerus. Pdf management of displaced surgical neck fractures of the. Maintain range of motion rom without displacing the proximal humerus fracture. The surgical neck of the humerus is the most common fracture site on the proximal humerus. Proximal humerus, threepart fracture, fourpart fracture, surgical treatment, orif. Treatment is nearly always nonoperative in younger patients due to the remodeling potential of the proximal humerus.
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