Difference between revisions of "Proximal humerus fracture"

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*Fracture of articular surface suggested by pseudosubluxation:
 
*Fracture of articular surface suggested by pseudosubluxation:
 
***Superior joint hematoma pushes humerus down
 
***Superior joint hematoma pushes humerus down
 +
 +
===Neer System===
 +
*Proximal humerus is divided into four "parts" based on epiphyseal lines:
 +
**Articular surface of humeral head
 +
**Greater tubercle
 +
**Lesser tubercle
 +
**Shaft of humerus
 +
*A "one-part" fracture is one in which fragment is displaced <1cm or not angulated >45deg
  
 
==Management==
 
==Management==
*Guided by the Neer System
 
**Proximal humerus is divided into four "parts" based on epiphyseal lines:
 
***Articular surface of humeral head
 
***Greater tubercle
 
***Lesser tubercle
 
***Shaft of humerus
 
**A "one-part" fx is one in which fragment is displaced <1cm or not angulated >45deg
 
 
*"One-part" fracture:
 
*"One-part" fracture:
 
**Sling and swathe, ice, ortho referral
 
**Sling and swathe, ice, ortho referral
 
*More than one-part fractures:
 
*More than one-part fractures:
 
**Ortho consult in the ED
 
**Ortho consult in the ED
 +
 +
==Disposition==
  
 
==See Also==
 
==See Also==

Revision as of 10:59, 10 June 2015

Background

  • Typically occur in elderly osteoporotic pts from FOOSH mechanism
  • Must rule-out axillary and brachial plexus neurovascular injuries
  • Greater tuberosity fx suggests rotator cuff tear
  • Lesser tuberosity fx suggests posterior shoulder dislocation
Prox humerus fracture.jpeg

Clinical Features

  • Pain, swelling, tenderness about the shoulder
  • Arm is held closely against chest wall

Differential Diagnosis

Humerus Fractures

Humeral anatomy

Shoulder and Upper Arm Diagnoses

Traumatic/Acute:

Nontraumatic/Chronic:

Refered pain & non-orthopedic causes:

Diagnosis

  • AP, lateral, and axillary radiographs
  • Fracture of articular surface suggested by pseudosubluxation:
      • Superior joint hematoma pushes humerus down

Neer System

  • Proximal humerus is divided into four "parts" based on epiphyseal lines:
    • Articular surface of humeral head
    • Greater tubercle
    • Lesser tubercle
    • Shaft of humerus
  • A "one-part" fracture is one in which fragment is displaced <1cm or not angulated >45deg

Management

  • "One-part" fracture:
    • Sling and swathe, ice, ortho referral
  • More than one-part fractures:
    • Ortho consult in the ED

Disposition

See Also

References