upper limbs-2

PROXIMAL HUMERAL FRACTURES


PROXIMAL HUMERAL FRACTURES
It is the second most common fractured upper limb bone
They are most frequent in elderly female patients.
About 80% are undisplaced which can be treated conservatively, and 20 % are displaces fractures most of them are tow parts or three parts fractures.

Neer’s classification is the most popular to use which depends on:
1- Number of fragments, degree of displacement, and dislocation.
2- The bony piece considered displaced : if it is
A- Having 1 CM a parted from the adjacent bone, and or
B- Having 45 degree angulation.

Notes
1- All undisplaced fractures are called (one part fracture) regardless to the number of fracture lines.
2- Tow parts fracture carrying four possibilities (anatomical neck, surgical neck, greater tuberosity or lesser tuberosity).
3- Three parts fracture ( surgical neck + either greater or lesser tuberosity)
4- Fracture dislocation (tow, three or four parts) + dislocation, and need to mention the direction of dislocation. (Anterior, Posterior etc.)

Clinical Features:-
Clinical examination reveals bruising and swelling of the shoulder.
The bruising migrates down the arm in the first 10-14 days after injury and eventually may be more obvious at the elbow.
Neurological injuries are present in 20-30% of older patients and tend to involve the axillary nerve or brachial plexus.