Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus

back to skeleton

Glossary

Extraarticular 2-part, greater tuberosity, nondisplaced

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Impacted greater tuberosity fractures Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Nonimpacted greater tuberosity fracture Some specialized surgical experience Full specialized surgical and imaging resources

Extraarticular 2-part, greater tuberosity, displaced

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Frail elderly patient Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Fracture that can be reduced closed Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Screw or suture fixation Inability to reduce closed Some specialized surgical experience Simple surgical and imaging resources

Extraarticular 2-part, tuberosity, dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Satisfactory reduction of the greater tuberosity after the glenohumeral joint is reduced Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Persistent displacement of the greater tuberosity after reduction of the glenohumeral dislocation Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - Screw or suture fixation Persistent or recurrent displacement of the greater tuberosity after reduction of the glenohumeral dislocation Some specialized surgical experience Simple surgical and imaging resources

Extraarticular 2-part, surgical neck, impaction

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable deformity Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Unacceptable deformity and/or risk of displacement Some specialized surgical experience Full specialized surgical and imaging resources
MIO - Plate fixation Unacceptable deformity and/or risk of displacement Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing (straight nail) Unacceptable deformity and/or risk of displacement Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing (bent nail) Unacceptable deformity and/or risk of displacement Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Screw fixation Unacceptable deformity and/or instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Unacceptable deformity and/or instability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular 2-part, surgical neck, no impaction

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Most fractures, even with significant translation Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Reducible fracture with good bone quality and appropriate fracture pattern Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Reducible fracture with poorer bone quality or transverse fracture pattern Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing (straight nail) Reducible fracture with a proximal segment suitable for nail fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing (bent nail) Reducible fracture with a proximal segment suitable for nail fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Need for open reduction and optimal fixation stability Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular 3-part, surgical neck and greater tuberosity, impaction

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimal displacement and/or elderly, infirm patient Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Satisfactory reduction and fixation can be achieved closed Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing Significant angulation plus tuberosity fracture not compromised by nail Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Both fracture components can be reduced closed Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Open exposure required for satisfactory reduction and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular 3-part, surgical neck and lesser tuberosity, impaction

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Acceptable angulation with good internal rotation strength or frail elderly patient Basic surgical experience, no specialized skills Basic equipment only
Nailing Unacceptable metaphyseal angulation; satisfactory internal rotation strength Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Unacceptable metaphyseal angulation; satisfactory internal rotation strength Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Unacceptable metaphyseal angulation and/or internal rotation weakness Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular 3-part, surgical neck and tuberosity, no impaction

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Reducible fracture with suitable pattern for screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Nailing Fracture can be reduced closed and has pattern suitable for nail fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Significantly displaced fracture that can be reduced closed Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Displacement and/or instability are unacceptable Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Extreme osteoporosis and/or comminution with severe displacement that is predictable of an unacceptable result; salvage after failure of alternative Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular 3-part, surgical neck and tuberosity, dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative 1) Successful closed glenohumeral reduction with satisfactory (minimally displaced) fracture alignment 2) Very frail elderly patient with minimal requirements for upper extremity use Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Successful closed glenohumeral reduction with fracture suitable for closed reduction and screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Successful closed glenohumeral reduction with fracture suitable for closed reduction and plate fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Need for open fracture reduction and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Irreparable fracture or failure of primary Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Isolated anatomical neck, slight displacement

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Closed reduction possible Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Screw fixation Open exposure required for reduction but well-suited fixation with multiple screws Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Open reduction required; maximal mechanical stability desired Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to obtain satisfactory reduction or fixation; salvage of failed reduction and fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Isolated anatomical neck, dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient; excessive surgical risk Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate or screw fixation Acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to reconstruct the fracture; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, slight displacement, valgus malalignment

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Less angulation/displacement and/or limited functional expectations Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Acceptable closed reduction of fracture suitable for fixation with screws alone Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Satisfactory reduction achieved closed Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Significant displacement or angulation that can not be corrected closed Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, slight displacement, varus malalignment

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Minimal varus angulation or elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
MIO - Screw fixation Deformity that can be corrected with closed reduction, fracture pattern suitable for fixation with screws alone Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Plate fixation Closed reduction is possible but plate is required for adequate stabilization Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plate fixation Open exposure required to obtain satisfactory reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, marked displacement, intact articular, valgus malalignment

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Less severe impaction and/or tuberosity displacement; elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate fixation Significant valgus and/or greater tuberosity displacement; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to obtain satisfactory reduction or fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, marked displacement, intact articular, varus malalignment

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate fixation Significant displacement; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Elder patient with poor bone quality; salvage of previous failure Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, marked displacement, fragmentary articular, varus malalignment

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate fixation Displacement involving articular surface and acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to reconstruct the fracture, particularly articular surface Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, dislocation, simple metaphyseal, intact articular

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient; excessive surgical risk Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate fixation Displacement of neck and/or tuberosities; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to reconstruct the fracture; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

4-Part, dislocation, fragmentary metaphyseal +/- fragmentary articular

Please select a treatment option:
Treatment Main indication Skill Equipment
Nonoperative Elderly infirm patient; excessive surgical risk Basic surgical experience, no specialized skills Basic equipment only
ORIF - Plate fixation Repairable proximal humerus fracture; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hemiarthroplasty Inability to reconstruct the fracture; acceptable surgical risk Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Reverse arthroplasty Displaced fractures in elderly patients Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2011-05-02