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Proximal Humerus Fractures Workup

  • Author: Mark A Frankle, MD; Chief Editor: S Ashfaq Hasan, MD  more...
 
Updated: May 05, 2015
 

Laboratory Studies

Routine preoperative laboratory studies for proximal humerus fractures include the following:

  • Complete blood count (CBC)
  • Basic metabolic panel
  • Coagulation studies
  • Type and cross-match
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Imaging Studies

Radiographic evaluation is the most important diagnostic tool for proximal humerus fractures. Incorrect views or poor quality radiographs can lead to errors in prognosticating outcome and an inappropriate choice of treatment.

The initial series for evaluating a patient with a suspected proximal humerus fracture is the trauma series, which consists of anteroposterior (AP) and lateral views in the scapular plane and an axillary view.

The scapula sits obliquely to the chest wall. Therefore, to achieve a true AP view, the x-ray beam must be tilted approximately 40° to plane of the thorax. Similarly, in the lateral view, the x-ray beam will parallel the scapular spine when the body is tilted 40°. The axillary view can be obtained with the use of the Velpeau view, allowing the arm to stay within the sling. In this view, the patient is seated and tilted backwards approximately 45°.

Use the AP projection to assess fracture displacements of the surgical neck (varus or valgus), the greater tuberosity (superior displacement), and the lesser tuberosity (medial displacement). The glenohumeral joint should be clearly visible. If overlap is seen, suspect dislocation. The lateral view is helpful in assessing flexion or extension of the surgical neck and posterior displacement of the greater tuberosity fragment.

The axillary view helps to assess tuberosity fragments, with anteromedial displacement of the lesser tuberosity fragment and posterior displacement of the greater tuberosity fragment. This view is critical in assessing the greater tuberosity fragment, as superior displacement may be absent and the infraspinatus can be completely avulsed with a posteriorly displaced fragment. Furthermore, dislocation of the head can be defined clearly on this view.

Linear tomography can help to assess nonunions of the surgical neck. However, it has been replaced by computed tomography (CT). In addition to surgical neck assessment, CT can provide information on articular involvement in head splitting fractures, impression fractures, chronic fracture dislocations, and glenoid rim fractures.[8] Tuberosity displacement can also be assessed.

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Contributor Information and Disclosures
Author

Mark A Frankle, MD Adult Reconstruction and Arthritis Orthopaedic Surgeon, Florida Orthopaedic Institute

Mark A Frankle, MD is a member of the following medical societies: American Medical Association, Florida Orthopaedic Society, Shoulder and Elbow Society of Australia, American Shoulder and Elbow Surgeons, American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association

Disclosure: Received consulting fee from DJO for consulting; Received royalty from DJO for other.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Pekka A Mooar, MD Professor, Department of Orthopedic Surgery, Temple University School of Medicine

Pekka A Mooar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

S Ashfaq Hasan, MD Associate Professor, Chief, Shoulder and Elbow Service, Department of Orthopaedics, University of Maryland School of Medicine

S Ashfaq Hasan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Shoulder and Elbow Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Jegan Krishnan, MBBS, FRACS, PhD Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Flinders Private Hospital

Jegan Krishnan, MBBS, FRACS, PhD is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Matthew Teusink, MD, and Raymond Long, MD, FRCSC, are gratefully acknowledged for contributions made to this article.

References
  1. Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970 Sep. 52(6):1077-89. [Medline].

  2. Dimakopoulos P, Potamitis N, Lambiris E. Hemiarthroplasty in the treatment of comminuted intraarticular fractures of the proximal humerus. Clin Orthop. 1997 Aug. (341):7-11. [Medline].

  3. Hartsock LA, Estes WJ, Murray CA. Shoulder hemiarthroplasty for proximal humeral fractures. Orthop Clin North Am. 1998 Jul. 29(3):467-75. [Medline].

  4. Monga P, Verma R, Sharma VK. Closed reduction and external fixation for displaced proximal humeral fractures. J Orthop Surg (Hong Kong). 2009 Aug. 17(2):142-5. [Medline].

  5. Bigliani LU, McCluskey GM 3rd. Prosthetic replacement in acute fractures of the proximal humerus. Semin Arthroplasty. 1990 Oct. 1(2):129-37. [Medline].

  6. Bastian JD, Hertel R. Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg. 2008 Jan-Feb. 17(1):2-8. [Medline].

  7. Fjalestad T, Hole MO, Blücher J, Hovden IA, Stiris MG, Strømsøe K. Rotator cuff tears in proximal humeral fractures: an MRI cohort study in 76 patients. Arch Orthop Trauma Surg. 2009 Aug 14. [Medline].

  8. Edelson G, Safuri H, Salami J, Vigder F, Militianu D. Natural history of complex fractures of the proximal humerus using a three-dimensional classification system. J Shoulder Elbow Surg. 2008 May-Jun. 17(3):399-409. [Medline].

  9. Hanson B, Neidenbach P, de Boer P, Stengel D. Functional outcomes after nonoperative management of fractures of the proximal humerus. J Shoulder Elbow Surg. 2009 Jul-Aug. 18(4):612-21. [Medline].

  10. Torrens C, Corrales M, Vilà G, Santana F, Cáceres E. Functional and Quality-of-Life Results of Displaced and Nondisplaced Proximal Humeral Fractures Treated Conservatively. J Orthop Trauma. 2011 Oct. 25(10):581-7. [Medline].

  11. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma. 2011 Oct. 25(10):612-7. [Medline].

  12. Iacobellis C, Serafini D, Aldegheri R. PHN for treatment of proximal humerus fractures: evaluation of 80 cases. Musculoskelet Surg. 2009 Sep. 93(2):47-56. [Medline].

  13. Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009 Mar. 23(3):163-72. [Medline].

  14. Gardner MJ, Boraiah S, Helfet DL, Lorich DG. The anterolateral acromial approach for fractures of the proximal humerus. J Orthop Trauma. 2008 Feb. 22(2):132-7. [Medline].

  15. Hatzidakis AM, Shevlin MJ, Fenton DL, Curran-Everett D, Nowinski RJ, Fehringer EV. Anglular-stable locked intramedullary nailing of two-part surgical neck fractures of the proximal part of the humerus. A multicenter retrospective observational study. J Bone Joint Surg Am. 2011. 93(23):2172-9. [Full Text].

  16. Hettrich CM, Neviaser A, Beamer BS, Paul O, Helfet DL, Lorich DG. Locked plating of the proximal humerus using an endosteal implant. J Orthop Trauma. 2012. 26(4):212-5. [Full Text].

  17. Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD. Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humerus fractures. J Shoulder Elbow Surg. 2012. 21(6):741-8. [Full Text].

  18. Handoll H, Brealey S, Rangan A, Keding A, Corbacho B, Jefferson L, et al. The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial - a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults. Health Technol Assess. 2015 Mar. 19(24):1-280. [Medline].

  19. Lenarz C, Shishani Y, McCrum C, Nowinski RJ, Edwards TB, Gobezie R. Is reverse shoulder arthroplasty appropriate for treatment of fractures in the older patient? Early observations. Clin Orthop Relat Res. 2011. 469(12):3324-31. [Full Text].

  20. Boyle MJ, Youn SM, Frampton CM, Ball CM. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg. 2013. 22(1):32-7. [Full Text].

  21. Liu K, Liu PC, Liu R, Wu X. Advantage of minimally invasive lateral approach relative to conventional deltopectoral approach for treatment of proximal humerus fractures. Med Sci Monit. 2015 Feb 15. 21:496-504. [Medline]. [Full Text].

  22. Yang H, Li Z, Zhou F, Wang D, Zhong B. A prospective clinical study of proximal humerus fractures treated with a locking proximal humerus plate. J Orthop Trauma. 2011 Jan. 25(1):11-7. [Medline].

  23. Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011 Jul. 20(5):747-55. [Medline].

  24. Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M, et al. Open reduction and internal fixation of proximal humerus fractures with the use of the locking proximal humerus plate. Results of a prospective, multicenter observational study. J Bone Joint Surg Am. 2009. 91(6):1320-8. [Full Text].

  25. Bahrs C, Rolauffs B, Dietz K, Eingartner C, Weise K. Clinical and radiological evaluation of minimally displaced proximal humeral fractures. Arch Orthop Trauma Surg. 2009 Oct 7. [Medline].

 
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