Jakob and colleagues described a four‑part proximal humeral fracture with valgus impaction of the head, a pattern not specifically covered by Neer's classification, and reported its results after closed or limited open reduction with minimal fixation.
Series of 19 fractures in 18 patients treated at the Inselspital, Berne, from 1974 to 1985, followed a mean of 4.2 years (range 2 to 10).
Methods
Design
Case series
Patients
18 patients
19 four‑part valgus impacted proximal humeral fractures
Treatment
Closed reduction and percutaneous Kirschner wires in 5
Open reduction and minimal internal fixation in 14
Follow-up
2 to 10 years (mean 4.2)
Outcomes
Avascular necrosis
Neer score
Key Findings
Results were satisfactory or excellent in 14 of 19 fractures (74%) after closed or limited open reduction with minimal fixation.
Avascular necrosis developed in 5 of 19 fractures (26%), lower than Neer reported for four‑part fractures, and it caused all 5 unsatisfactory or failed results.
Every case of avascular necrosis with collapse was diagnosed within 2 years of injury.
All fractures united, at an average of 6 to 8 weeks after surgery, with no infection, malunion or loss of reduction.
The mean Neer score was 81 points (range 41 to 94), and every shoulder had some loss of motion.
Board pearl
The valgus impacted four‑part fracture has four fragments, with the head impacted into valgus and the tuberosities variably displaced, and the authors proposed that a head angulated without translation keeps enough soft‑tissue attachment to stay viable.
Authors' conclusion
The major reason for failure was avascular necrosis (26%), which accounted for all five of our poor results. This relatively low incidence suggests that discarding the humeral head and proceeding to arthroplasty is not indicated.
Jakob and colleagues described a four‑part proximal humeral fracture with valgus impaction of the head, a pattern not specifically covered by Neer's classification, and reported its results after closed or limited open reduction with minimal fixation.
Series of 19 fractures in 18 patients treated at the Inselspital, Berne, from 1974 to 1985, followed a mean of 4.2 years (range 2 to 10).
Methods
Design
Case series
Patients
18 patients
19 four‑part valgus impacted proximal humeral fractures
Treatment
Closed reduction and percutaneous Kirschner wires in 5
Open reduction and minimal internal fixation in 14
Follow-up
2 to 10 years (mean 4.2)
Outcomes
Avascular necrosis
Neer score
Key Findings
Results were satisfactory or excellent in 14 of 19 fractures (74%) after closed or limited open reduction with minimal fixation.
Avascular necrosis developed in 5 of 19 fractures (26%), lower than Neer reported for four‑part fractures, and it caused all 5 unsatisfactory or failed results.
Every case of avascular necrosis with collapse was diagnosed within 2 years of injury.
All fractures united, at an average of 6 to 8 weeks after surgery, with no infection, malunion or loss of reduction.
The mean Neer score was 81 points (range 41 to 94), and every shoulder had some loss of motion.
Board pearl
The valgus impacted four‑part fracture has four fragments, with the head impacted into valgus and the tuberosities variably displaced, and the authors proposed that a head angulated without translation keeps enough soft‑tissue attachment to stay viable.
Authors' conclusion
The major reason for failure was avascular necrosis (26%), which accounted for all five of our poor results. This relatively low incidence suggests that discarding the humeral head and proceeding to arthroplasty is not indicated.