Elsevier

Journal of Shoulder and Elbow Surgery

Volume 3, Issue 5, September–October 1994, Pages 273-287
Journal of Shoulder and Elbow Surgery

Two-part fractures of the proximal humerus

https://doi.org/10.1016/S1058-2746(09)80071-2Get rights and content

Between 1981 and 1991, 137 patients had 141 two-part proximal humerus fractures. One hundred thirteen surgical neck, 24 greater tuberosity, 2 anatomic neck, and 2 lesser tuberosity fractures were studied. Eleven patients had died in the interim; the remaining cases were reviewed. The mean age of patients with surgical neck fractures was 57 years (range 20 to 91 years), and 62.8% (71 cases) were women. In 38% of cases there was another significant medical problem. Eighty (70.8%) cases were treated with a sling and early isometric and pendulum exercises. Bony union was obtained in an average of 3.2 months (range 2 to 8 months), and 87.5% achieved satisfactory function. The mean age of patients with greater tuberosity fractures was 37 years (range 20 to 59 years), and 79.2% (19 cases) were men. Ten (41.7%) cases were treated with open reduction and internal fixation, and the remainder were treated without surgery. All patients improved to a satisfactory level of function. Anatomic neck fractures (two) were treated with surgery. Lesser tuberosity fractures (two) were treated conservatively and had good functional results. It appears that conservative measures when coupled with early isometric and pendulum exercises produce a satisfactory result in surgical neck fractures. Similarly, conservative treatment for nondisplaced greater tuberosity fractures and operative intervention for displaced fractures resulted in satisfactory function. Lesser tuberosity fractures without limitation of motion appear to do well with a sling and early motion.

References (67)

  • LU Bigliani

    Fractures of the proximal humerus

  • DM Bosworth

    Blade plate fixation

    JAMA

    (1949)
  • F Brostrom

    Early mobilization of fractures of the upper end of the humerus

    Arch Surg

    (1943)
  • IF Ciernik et al.

    Humeral mobility after treatment with hanging cast

    J Trauma

    (1991)
  • EA Codman

    Rupture of the suprospinatus tendon and other lesions in or about the subacromial bursas

  • RH Cofield

    Comminuted fractures of the proximal humerus

    Clin Orthop

    (1988)
  • E Dehne

    Fractures at the upper end of the humerus

    Surg Clin North Am

    (1945)
  • AF DePalma

    Fractures of the proximal humerus

  • AF DePalma et al.

    Fractures of the upper end of the humerus

    Clin Orthop

    (1961)
  • J Earwaker

    Isolated avulsion fracture of the lesser tuberosity of the humerus

    Skeletal Radial

    (1990)
  • Editorial. Proximal humeral fractures

    Injury

    (1981)
  • T Ekström et al.

    Procaine injections and early mobilisation for fractures of the neck of the humerus

    Acta Chir Scand

    (1965)
  • EL Flatow et al.

    Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus

    J Bone Joint Surg [Am]

    (1991)
  • GJ Garceau et al.

    Early physical therapy in the treatment of fractures of the surgical neck of the humerus

    Indiana Med

    (1941)
  • O Hägg et al.

    Aspects of prognostic factors in comminuted and dislocated proximal humeral fractures

  • MC Hall et al.

    The structure of the upper end of the humerus, with reference to osteoporotic changes in senescence leading to fractures

    Can Med Assoc J

    (1963)
  • J Horak et al.

    Epidemiology of fracture of the upper end of the humerus

    Clin Orthop

    (1975)
  • NJ Howard et al.

    Treatment of fractures of the upper end of the humerus: an experimental and clinical study

    J Bone Joint Surg

    (1934)
  • RP Jakob et al.

    Classification and aspects of treatment of fractures of the proximal humerus

  • JS Keene et al.

    Proximal humeral fractures, a correlation of residual deformity with long term function

    Orthopedics

    (1983)
  • T Kiær

    Fractures of the proximal humerus: the relation of Neer classification to the course of healing

    Acta Orthop Scand

    (1985)
  • RA Knight et al.

    Comminuted fractures and fracture-dislocations involving the articular surface of the humeral head

    J Bone Joint Surg [Am]

    (1957)
  • T Kocher

    Die Fracturen am oberen Humerusende

  • Cited by (31)

    • Additional cuff suture provides mechanical advantage for fixation of split-type greater tuberosity fracture of humerus

      2022, Injury
      Citation Excerpt :

      The incidence of greater tuberosity is 14 – 20 % of all proximal humeral fracture. It is usually found in young patients with high-energy trauma and in elderly or osteoporotic patients with low-energy trauma [1–3]. It has been classified into three types (split, avulsion, and depression).

    • Shoulder and proximal humerus

      2021, Skeletal Trauma: A Mechanism-Based Approach of Imaging
    • Outcomes of surgical fixation of greater tuberosity fractures: A systematic review

      2020, Orthopaedics and Traumatology: Surgery and Research
      Citation Excerpt :

      Isolated greater tuberosity fracture is an injury that is primarily seen as a result of either impaction on the acromion, impaction on the glenoid during dislocation, or avulsion and shearing. Accounting for up to 20% of all proximal humeral fractures [1–3], these injuries present as acute shoulder pain with reduced range of motion and are typically diagnosed via standard radiographs. While the vast majority of greater tuberosity fractures are minimally or non-displaced and can be treated without surgery [4,5], there remains debate as to the degree of displacement that indicates surgical treatment [4,6,7].

    • Fractures of the Proximal Humerus

      2016, Rockwood and Matsen’s The Shoulder
    • Surgical management of isolated greater tuberosity fractures of the proximal humerus

      2014, Orthopedic Clinics of North America
      Citation Excerpt :

      Paavolainen and colleagues39 reported good results in 6 patients treated with screw fixation for an isolated greater tuberosity fracture. In a retrospective review Chun and colleagues40 reported results of 24 isolated greater tuberosity fractures included in a series of 141 2-part proximal humerus fractures. Ten of the 24 were treated with ORIF, 8 of which were fixed with screws.

    View all citing articles on Scopus
    View full text