Anatomy
This blood vessel serves as an anatomic landmark demarcating the plane of dissection during a deltopectoral approach.
Cephalic vein
The Neer classification of proximal humerus fractures is based on the anatomic relationship of these 4 segments.
Greater tuberosity
Lesser tuberosity
Articular surface
Humeral shaft
The greater tuberosity displacement threshold indicating surgical treatment with ORIF.
5 mm
This nerve is the most commonly injured in proximal humerus fracture patients, with EMG studies demonstrating evidence of injury in up to 58% of cases.
Axillary nerve
Improved
Improved
The most common proximal humerus fracture is a 2-part fracture involving the ______.
Surgical neck
This radiographic view, obtained by leaning the patient 30-45 degrees backwards over the detector, can be substituted for an axillary view in patients unable to abduct the arm due to pain or immobilization.
Velpeau
This procedure is often considered for elderly patients with complex proximal humerus fractures as well as those with irreparable rotator cuff damage.
Reverse shoulder arthroplasty
Age
Smoking
According to Goudie et al., the prevalence of nonunion at 24 weeks after nonoperative management of proximal humerus fracture is _____%.
10.4%
The average angulation and version of the humeral head relative to the shaft.
Angulation: 135 degrees
Version: 30-40 degrees of retroversion relative to transepicondylar axis of distal humerus
This injury pattern, typically seen in elderly patients with osteoporotic bone, is characterized by medial comminution, varus collapse, and increased risk of fixation failure.
Varus-impacted fracture
When performing ORIF with a locking plate, this crucial step plays an important role in reducing risk for varus collapse.
Placement of inferomedial calcar screw
This is the most common complication affecting patients following locking plate fixation of proximal humerus fractures.
Screw cut-out
Name 2 of the 5 "Hertel Criteria" representing risk factors for humeral head ischemia following proximal humerus fracture.
1. <8 mm intact calcar attached to articular segment
2. disrupted medial hinge
3. Increasing fracture complexity
4. >10 mm displacement
5. >45 degrees angulation
These 6 muscles contribute the deforming forces acting upon a 4-part proximal humerus fracture.
GT - pulled superiorly and posteriorly by supraspinatus/infraspinatus/teres minor
LT - pulled medially by subscapularis
Shaft - pulled anteromedially by pectoralis major, proximally by deltoid
Along with intracapsular hematoma, this associated finding is responsible for the inferior humeral head pseeudosubluxation commonly seen in patients with proximal humerus fractures.
Deltoid atony
When placing an intramedullary nail, there is risk of injury to the _____ nerve when placing the anterior-posterior screw and to the _____ nerve when placing the lateral-medial screw.
Musculocutaneous
Radial
Malunion or nonunion of the greater tuberosity after proximal humerus ORIF may result in these functional limitations.
Weakness/decreased shoulder ROM in external rotation and abduction.
Hertel and colleagues used this method in conjunction with laser doppler flowmetry to assess humeral head perfusion.
Drill borehole(s) in the head and look for backflow.
An intraosseous extension of the ascending anterolateral branch of the anterior circumflex humeral artery, this vessel provides the main blood supply to the greater tuberosity.
Arcuate artery
This was the reason Dr. Neer chose 45 degrees of angulation and 1 cm of separation as thresholds for displacement when classifying proximal humerus fractures.
Journal editor request
Dr. Thornton Brown, the editor of Neer's original article submitted to JBJS, insisted on distinct thresholds. Neer later shared these were arbitrarily set and not intended to dictate treatment.
Published in JAMA in 2015, this landmark study found no significant differences in patient-reported outcomes following operative vs. nonoperative management of 2-part surgical neck fractures.
The Proximal Fracture of the Humerus Evaluation by Randomization (PROFHER) trial
A recent JSES study out of our department reported patients aged >60 years to have an overall surgical complication rate of _____ % at an average of 6.1 years after locking plate fixation of proximal humerus fracture. (+/- 5% acceptable)
44%
(34% were considered radiographic failures, 11% required reoperation)
Name 2 of 3 independent predictors of nonunion after nonoperative management of proximal humerus fractures according to Goudie et al.
Decreasing head-shaft angle
Increasing head-shaft translation
Smoking