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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

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 However, it has been replaced by computed tomography (CT).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.

Contributor Information and Disclosures

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.


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

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