Five to seven percent of all fractures involve the humerus, with most occurring in ladies over the age of 60 who have osteoporosis. and suffer fractures after a simple fall. In younger individuals such fractures result from high energy injuries (road traffic accidents). Around 75% are non-displaced fractures according to Neer's classification and can be treated non-operatively. The remaining 25% require surgical intervention based on the understanding of the anatomy of the proximal, the mechanism of the injury and the quality of the patient's bone. The displaced fractures may lead to avascular necrosis, osteoarthritis, pseudoarthrosis, and reduced motion and function. Involvement of the specialist is needed at an early stage in order to restore the limb functionality and the quality of life.
Adedapo AO, Ikpeme JO2001. The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury32: 115-21.
2.
Agudelo J., Schürmann M., Stahel P., Helwig P., Morgan SJ, Zechel W., Bahrs C., Parekh A., Ziran B., Williams A., Smith W.2007. Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. Journal of Orthopaedic Trauma21: 676-81.
3.
Atalar AC, Demirhan M., Uysal M., Seyahi A.2007. Treatment of Neer type 4 impacted valgus fractures of the proximal humerus with open reduction, elevation, and grafting. Acta Orthopaedica et Traumatologica Turcica41: 113-19.
4.
Ballmer FT, Hertel R.1998. Indications and results of shoulder prosthetics in complex proximal humerus fractures. Therapeutische Umschau. Revue Thérapeutique55: 197-202.
5.
Bernstein J., Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP1996. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs . The Journal of Bone and Joint Surgery. American Volume78: 1371-75.
6.
Bhandari M., Matthys G., McKee MD2004. Four part fractures of the proximal humerus. Journal of Orthopaedic Trauma18: 126-27.
7.
Brooks CH, Revell WJ, Heatley FW1993. Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. The Journal of Bone and Joint Surgery. British Volume75: 132-36.
8.
Codman EA, Akerson IB1931. The Pathology Associated with rupture of the supraspinatus tendon. Ann Surg93(1): 348-59.
9.
Edelson G., Kelly I., Vigder F., Reis ND2004. A three-dimensional classification for fractures of the proximal humerus. The Journal of Bone and Joint Surgery. British Volume86: 413-25.
10.
Edelson G., Safuri H., Salami J., Vigder F., Militianu D.2008. Natural history of complex fractures of the proximal humerus using a three-dimensional classification system. Journal of Shoulder and Elbow Surgery, (epub: 16 2 2008).
11.
Egol KA, Ong CC, Walsh M., Jazrawi LM, Tejwani NC, Zuckerman JD2008. Early Complications in proximal humerus fractures (OTA types 11) treated with locked plates. Journal of Orthopaedic Trauma22: 159-64.
12.
Gallay SH, McKee MD2000. Operative treatment of nonunions about the elbow . Clinical Orthopaedics and Related Research00: 87-101.
13.
Gardner MJ, Griffith MH, Dines JS, Lorich DG2004. A minimally invasive approach for plate fixation of the proximal humerus. Bulletin (Hospital for Joint Diseases (New York N.Y.))62: 18-23.
14.
Gerber C., Schneeberger AG, Vinh TS1990. The arterial vascularization of the humeral head. An anatomical study. The Journal of Bone and Joint Surgery. American Volume72: 1486-94.
15.
Gibbs J., Ricketts D.2005. Internal fixation of complex fractures of the proximal humerus. The Journal of Bone and Joint Surgery. British Volume 87: 884.
16.
Green A., Izzi Jr J.2003. Isolated fractures of the greater tuberosity of the proximal humerus. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons12: 641-49.
17.
Green A.1998. Current concepts of shoulder arthroplasty. Instructional Course Lectures47: 127-33.
18.
Handschin AE, Cardell M., Contaldo C., Trentz O., Wanner GA2008. Functional results of angular-stable plate fixation in displaced proximal humeral fractures. Injury39: 306-13.
19.
Helmy N., Hintermann B.2006. New trends in the treatment of proximal humerus fractures . Clinical Orthopaedics and Related Research442: 100-08.
20.
Hertel R., Hempfing A., Stiehler M., Leunig M.2004. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. Journal of Shoulder and Elbow Surgery/American Shoulder and Elbow Surgeons13: 427-33.
21.
Hertel R.1998. Complex trauma of the shoulder girdle. Der Orthopäde27: 2-10.
22.
Hodgson S.2006. Proximal humerus fracture rehabilitation. Clinical Orthopaedics and Related Research442: 131-8.
23.
Jakob RP, Miniaci A., Anson PS, Jaberg H., Osterwalder A., Ganz R.1991. Four-part valgus impacted fractures of the proximal humerus . The Journal of Bone and Joint Surgery. British Volume73: 295-8.
24.
Jiang Cy, Wang My, Rong Gw.2003. Humeral head replacement for the complex treatment of proximal humerus fractures. Zhonghua wai ke za zhi (Chinese Journal of Surgery)41: 649-53.
25.
Kazakos K., Lyras DN, Galanis V., Verettas D., Psillakis I., Chatzipappas Ch, Xarchas K.2007. Internal fixation of proximal humerus fractures using the Polarus intramedullary nail. Archives of Orthopaedic and Trauma Surgery127: 503-8 (epub: 10 Jul).
26.
Khunda A., Stirrat AN, Dunlop P.2007. Injury to the axillary artery, a complication of fixation using a locking plate. The Journal of Bone and Joint Surgery. British Volume89: 1519-21.
27.
Kirsch LB, Herscovici Jr D., Creevy W.2001. Proximal humerus fracture. Journal of Orthopaedic Trauma15: 146-48.
28.
Koukakis A., Apostolou CD, Taneja T., Korres DS, Amini A.2006. Fixation of proximal humerus fractures using the PHILOS plate: early experience. Clinical Orthopaedics and Related Research442: 115-20.
29.
Kristiansen B., Kofoed H.1987. External fixation of displaced fractures of the proximal humerus. Technique and preliminary results. The Journal of Bone and Joint Surgery. British Volume69: 643-6.
30.
Laflammen GY, Rouleau DM, Berry GK, Beaumont PH, Reindl R., Harvey EJ2008. Percutaneous humeral plating of fractures of the proximal humerus: results of a prospective multicenter clinical trial. Journal of Orthopaedic Trauma22: 153-58.
31.
Lill H., Josten C.2000. Proximal and distal humerus fractures in advanced age . Der Orthopäde29: 327-41.
32.
McKoy BE, Bensen CV, Hartsock LA2000. Fractures about the shoulder: conservative management . The Orthopedic Clinics of North America31: 205-16.
33.
Misra A., Kapur R., Maffulli N.2001. Complex proximal humeral fractures in adults-a systematic review of management. Injury32: 363-72.
34.
Moonot P., Ashwood N., Hamlet M.2007. Early results for treatment of three- and four-part fractures of the proximal humerus using the PHILOS plate system. The Journal of Bone Joint Surgery British volume 89-B: 1206-09.
35.
Mostafavi HR, Tornetta P.3rd.1997. Open fractures of the humerus treated with external fixation . Clinical Orthopaedics and Related Research00: 187-97.
36.
Naranja Jr RJ, Iannotti JP2000. Displaced three- and four-part proximal humerus fractures: evaluation and management. The Journal of the American Academy of Orthopaedic Surgeons8: 373-82.
37.
Neer CS2nd.2002. Four-segment classification of proximal humeral fractures: purpose and reliable use. Journal of Shoulder and Elbow Surgery/American Shoulder and Elbow Surgeons11: 389-400.
38.
Neer CS2nd.2006. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clinical Orthopaedics and Related Research442: 77-82.
39.
Neer CS2nd.1987. Displaced proximal humeral fractures. Part I. Classification and evaluation. Clinical orthopaedics and related research00: 3-10.
40.
Neer CS2nd.1994. Fracture classification systems: do they work and are they useful?. The Journal of Bone and Joint Surgery. American Volume 76: 789-90.
41.
Neer CS, Brown Jr TH, Mclaughlin HL1953. Fracture of the neck of the humerus with dislocation of the head fragment. American Journal of Surgery85: 252-58.
42.
Regel G., Seekamp A., Blauth M., Klemme R., Kuhn K., Tscherne H.1996. Complex injury of the elbow joint. Der Unfallchirurg99: 92-99.
43.
Resch H., Povacz P., Fröhlich R., Wambacher M.1997. Percutaneous fixation of three- and four-part fractures of the proximal humerus. The Journal of Bone and Joint Surgery. British Volume79: 295-300.
44.
Ring D.2007. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury38: S59-68.
45.
Robinson CM, Khan LAK, Akhtar MA2006. Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation. The Journal of Bone and Joint Surgery. British Volume88: 502-8.
46.
Robinson CM, Page RS2004. Severely impacted valgus proximal humeral fractures. The Journal of Bone and Joint Surgery. American Volume 86-A: 143-55.
47.
Sanchez SJ2006. Proximal humerus fractures. Clinical anatomy (New York N.Y.)19: 588-98.
48.
Sidor ML, Zuckerman JD, Lyon T., Koval K., Cuomo F., Schoenberg N.1993. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility . The Journal of Bone and Joint Surgery. American Volume75: 1745-50.
49.
Siebenrock KA, Gerber C.1993. The reproducibility of classification of fractures of the proximal end of the humerus. The Journal of Bone and Joint Surgery. American Volume75: 1751-55.
50.
Smith J., Berry G., Laflamme Y., Blain PE, Reindl R., Harvey E.2007. Percutaneous insertion of a proximal humeral locking plate: an anatomic study. Injury38: 206-11(epub: 25 Oct 2006).
51.
Vallier HA2007. Treatment of proximal humerus fractures. Journal of Orthopaedic Trauma21: 469-76.
52.
Visser CP, Coene LN, Brand R., Tavy DL2001. Nerve lesions in proximal humeral fractures. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons10: 421-27.
53.
Zyto K.1998. Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients. Injury, 29349-52.
