Humerus Fracture Workup

Updated: Sep 24, 2015
  • Author: Adarsh K Srivastava, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Workup

Imaging Studies

See the list below:

  • For the distal and diaphyseal humeral fractures, anteroposterior and lateral views of the humerus, as well as transthoracic and axillary views of the shoulder, should be adequate to visualize a fracture.
  • CT scans are helpful if radiographs are unclear.
  • Proximal humerus fracture
    • The humeral head articulates with the scapular glenoid.
    • The proximal humerus has 4 parts: articulating surface (anatomical neck), greater tuberosity, lesser tuberosity, and humeral shaft. The surgical neck is just distal to both tuberosities.
    • The minimum baseline studies for the evaluation of proximal humeral fractures must include a true anteroposterior (AP) view of the scapula and glenohumeral joint, an axillary view, and a lateral Y view of the scapula, evaluating the glenohumeral joint and proximal humerus in 3 perpendicular planes. [13]
    • All greater tuberosity fractures should, at some point, have an ultrasound examination or an MRI to check the integrity of the rotator cuff.
    • Blood is supplied to the humeral head from branches off the axillary artery. Blood travels distally to proximally. Fractures of the anatomical neck may affect blood supply and result in avascular necrosis of the humeral head.
  • Neer classification system is the commonly used terminology to describe proximal humerus fractures. [3] See the image below.
    Neer classification. Neer classification.
    See the list below:
    • If any of the 4 segments is separated by more than 1 cm from its neighbor or is angulated more than 45°, the fracture is said to be displaced.
    • One-part fractures are nondisplaced fractures or fractures with minimal displacement.
    • Two-part fractures are fractures in which only a single segment is displaced in relation to the other three.
    • Three-part fractures occur when two segments are displaced in relation to the other two parts. [14]
    • Four-part fractures exist when all the humeral segments are displaced.
    • Operative treatment decisions are based primarily on the number of segments involved and degree of displacement. Most fractures are displaced minimally and treated conservatively. Often, 3- and 4-part fractures require surgical management due to damage of the vasculature of the humeral head.
  • Diaphyseal fractures - Classified as simple, wedge, or complex (comminuted)