Introduction
Proximal humeral fractures are frequently seen after falls in the elderly, or after high energy trauma in younger people
Anatomy
The proximal humerus comprises four "parts" (corresponding to the growth centers): the head, the shaft and the greater and lesser tuberosities. Fracture lines typically separate these parts, giving rise to recognizable patterns. These patterns are the basis of the Neer /Codman classification.
Pathogeneis
Proximal humerus fractures result from direct trauma; the pull of the rotator cuff can also avulse a bony fragment.
Natural History
Non-displaced fractures usually do well. Multi-part fractures, often with associated injuries, usually lead to imperfect results
Patient History and Physical Findings
Imaging and Diagnostic Studies
It is critical that adequate x-rays are obtained. The trauma series of AP/Y/Axillary views are mandatory.
CT scanning was shown to not be very helpful.
Differential Diagnosis
The diagnosis of a fracture should be readily made from plain radiographs. The tricky issue is determining displacement and, in turn, where the fragments lie. Also, the soft tissue injury (cuff, labrum, articular surface) must be defined. For that MRI is helpful.
Treatment
Non operative treatment is best for non displaced fractures.
Displaced fractures need either ORIF or replacement. Percutaneous
Pearls and Pitfalls
Don't miss a fracture dislocation
Document the status of the axillary nerve
Don't miss a cuff tear that needs fixing
A displaced Greater Tuberosity fragment may lead to true impingement
Postoperative Care
Include immediate postoperative care and rehabilitation
Outcome
Include functional and prosthetic survivorship data as applicable
Complications
Include overview of complications
Selected References
Insert selected references and landmark articles
