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Diagnostic imaging of proximal humerus fractures

Fractures of the proximal humerus account for 5 to 7% of all fractures. 85% of these injuries are minimally displaced or undisplaced, considered stable and treated conservatively A fracture is considered significantly unstable only if a fragment is displaced from its anatomic position by more than l cm or at angle > 450. These injuries require surgery for optimal results. The Neer classification of proximal humeral fractures is based on the presence or absence of displacement of one or more of the four potential fracture fragments: humeral head, great tuberosity, lesser tuberosity and humeral shaft. According to Neer: - one-part fractures may contain any number of nondisplaced or minimally displaced fragments - two - part fractures have one major displaced fracture fragment - three-part fractures - the head is separated from the shalt and one of the tuberosities - four part fractures - displacement occurs between all four major fragments Imaging requirements for these injuries include conventional radiographic projections: scapular AP view, scapular lateral or "Y" view and axilar view. CT scans may increase the reliability and are helpful in: determination of displacement and rotation of fragments and their relationship to the glenoid fossa ; determination of the size of articular surface defects and complications following treatment ; can replace the axillary view when pain precludes positioning.

proximal humerus fractures

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