Humeral head fractures

Humeral head fracture occurs most often in older patients (in young people, the shoulder joint is more likely to luxate, in children it is more likely to be epiphyseolysis of the head).

AO classification
A – extra-articular two-fragmented

B – extra-articular three-fragmented

C - intra-articular

Neer classification
by number of fragments

corresponding to 4 anatomical zones


 * head
 * tuberculum majus
 * tuberculum minus
 * diaphysis

according to their dislocation

i.e. displacement over 1 cm or deflection over 45°


 * I - no dislocation (any number of fragments)
 * II – two-fragment with dislocation
 * III – three-fragment with dislocation
 * IV – four-fragment with dislocation

Classification according to Zeman

 * anatomical neck fracture


 * surgical neck fracture


 * fracture of the tuberculum majus


 * fracture of tuberculum minus


 * anterior luxation fractures


 * posterior luxation fractures

according to fragment dislocation


 * adduction or abduction fracture

dislocated fragments


 * breaking off the "tuberculum majus" - pull of the tendon m. supraspinatus (rotator cuff)


 * breaking off the "tuberculum minus" - pull of the tendon m. subscapularis medially


 * fracture of the collum chirurgicum – traction of the distal fragment medially (attachment m. pectoralis major)

If both cusps are broken off with a neck fracture, the head is at risk of avascular necrosis (in general, the head is at risk in intra-articular fractures, which have a worse prognosis than extra-articular)

Clinical picture and diagnosis
Diagnosis
 * changes in configuration of the shoulder, swelling, antalgic posture, limited movement, crepitation of fragments, runaway hematomas, in luxation fractures, an empty socket of the shoulder joint
 * it is necessary to examine the innervation (injury of n. axillaris in neck fractures) and pulse on a. radialis
 * x-ray in two projections

Conservative (mainly for Type A)

 * not dislocated, dislocated stable after reduction
 * immobilization in abduction for 3-4 weeks (Desault bandage with axilla padding, abduction splint - 30° forearm flexion and 60° abduction, hanging plaster, scarf sling)
 * early rehabilitation

Operational (Types B and C)

 * closed irreplaceable or reposable non-retinable, open and dislocation fractures, fractures complicated by injury to blood vessels and nerves:
 * closed reduction and MIO (e.g. intramedullary osteosynthesis according to Hacketal)
 * open reduction and plate osteosynthesis (T-plate, PHILOS – proximal humeral internal locking system)
 * secured nail (PHN – proximal humeral nail)
 * screws, K-wires, traction cerclage in multifragmented fractures
 * CKP in comminuted fractures with risk of avascular necrosis of the head

Specific treatment solutions

 * tuberosity fractures - non-dislocated: rest on a sling for 7 days, dislocated: screws or traction cerclage
 * neck fractures - non-dislocated immobilization in Desault for 3-4 weeks (in the young, where there is no such risk of shoulder stiffness), hanging plaster for 4-6 weeks in the elderly (allows early swinging movements in the shoulder), during surgical treatment plate osteosynthesis (PHILOS ) or PHN
 * multifragmentary head fractures - surgical treatment with osteosynthesis (screws, K-wires), possibly CKP

Related articles

 * Bones of the upper limb
 * Fractures of the diaphysis of the humerus