Proximal humeral fracture

Classification according to ICD-10
S42.2	Fracture of the proximal end of the humerus
S42.20	Part unspecified
S42.21	Head, proximal epiphysis, humeral head fracture with two to four fragments
S42.22	Collum chirurgicum humeri
S42.23	Collum anatomicum
S42.24	Greater tuberosity
S42.29	Other and multiple parts, lesser tuberosity
ICD-10 online (WHO version 2019)

The proximal humerus fracture , synonymous humerus head fracture , (imprecise: subcapital humerus fracture ) is a fracture form of the portion of the humerus near the trunk with an increasing incidence . With around 100 cases per 100,000 inhabitants per year, it is one of the most common fractures and accounts for 5% of all bone fractures .

The proximal humerus fracture occurs particularly often with osteoporosis , and in older patients an osteoporosis diagnosis including bone density measurement should be carried out, if this has not already been carried out, and therapy should be initiated.

60–80% of proximal humerus fractures can be treated conservatively if the fragments have shifted by less than 1 cm or the angle is tilted by less than 45 ° (classification according to Neer, Group I).

Pathomechanism and Incidence

proximal humerus fracture

The cause is often lighter falls in older women, who have a significantly higher risk of this type of fracture if they have osteoporosis. Women are affected twice as often as men (female> male: 2-3: 1), with an incidence of over 400/100,000 for this fracture in women over 70 years of age. The trauma is often indirect, falling on the outstretched hand or elbow leads to a compression fracture mostly in the area of ​​the surgical collum . In children, the fracture often occurs as an epiphyseal plate fracture and is also one of the most common fractures with about 4% of all extremity fractures in children. In children, the fracture is classified according to the AO classification for children and has the forms 1.1E / 1-2 or 1.1M / 2-3. In addition, if the epiphyseal is involved, a classification according to Salter-Harris can be used, which here as Salter I-II according to 1.1E / 1 (Salter I) and 1.1E / 2 (Salter II) (see also classifications)

Tumor metastases can also lead to pathological fractures in this area, but are less responsible for the proximal humerus fracture than the trauma.

Diagnosis

It is important to have anamnesis and a description of the fall, but an apparently slight fall from a low height can also cause a fracture in an osteoporotic bone. If you fall on your outstretched arm, the wrist, elbow and shoulder joints should also be examined.

If a fracture is suspected, an X-ray should also show the adjacent joints, for this an image from the front (ap - anterior-posterior beam path) and an image through the shoulder blade (transcapular, Y image) are made, a computed tomography (a CT) can Show accompanying injuries, especially of the shoulder joint, more clearly in the case of more complex fractures . In the case of a pathological fracture , magnetic resonance imaging can show the tumor better than CT.

Classification

The AO classification can also describe proximal humerus fractures, but these fractures are classified according to Neer in the clinic. There is no known standardized treatment in the form of a guideline in adults. In general, however, treatment is based on Neer's classification.

therapy

Around 60-80% of proximal humerus fractures can be treated conservatively, but the underlying osteoporosis should be considered carefully and treated if necessary. Conservative therapy consists of applying a Gilchrist or Desault bandage for 8 days (2-3 weeks) or until freedom from pain is achieved. In addition, functional treatment lasting six weeks is carried out through physiotherapeutic exercises from the 8th day onwards. Regular x-ray monitoring of the fracture is recommended.

If the fragment is dislocated by more than 1 cm (according to Neer) or more than 0.5 cm (according to Lill) or if the angle between the two fragments is more than 45 °, as well as more complex fractures, surgical therapy should be carried out.

See also

• Richard Poelchen (1857–1947), advocated the functional treatment of the subcapital humeral fracture

literature

• Klaus J. Burkhart, Sven O. Dietz, Leonard Bastian, Ulrich Thelen, Reinhard Hoffmann, Lars P. Müller: Treatment of the proximal humerus fracture in adults . In: Dtsch Arztebl International . tape 110 , no. 35-36 , 2013, pp. 591–597 , doi : 10.3238 / arztebl.2013.0591 ( online [accessed April 25, 2014]).
• 006-040l S1 Upper arm fracture Humerus fracture proximal 2013-12.pdf . In: AWMF online . ( online [PDF; accessed April 25, 2014]).
• Rudolf Berchtold, Hans-Peter Bruch, R Keller: Surgery: 335 tables and 343 practical questions; [according to the new AO; plus DVD] . Elsevier, Urban & Fischer, Munich et al. 2006, ISBN 3-437-41921-8 .
• Markus Müller: Surgery for study and practice: taking into account the subject catalog and the oral exams in the medical exams . Medical publishing and information services, Breisach am Rhein 2012, ISBN 978-3-929851-10-6 .
• Rüdiger Döhler , Rainer Feeser: The helix wire in proximal humeral fractures. A preliminary report on 20 patients. In: Osteosynthesis International. 8 (2000), pp. 224-227.

Individual evidence

1. ↑ ^{a b c} Markus Müller: Surgery for study and practice: taking into account the subject catalog and the oral exams in the medical exams . Medical publishing and information services, Breisach am Rhein 2012, ISBN 978-3-929851-10-6 .
2. ↑ Guideline on proximal humerus fractures in children. (No longer available online.) Archived from the original on April 26, 2014 ; Retrieved April 25, 2014 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.   
3. ↑ Proximal humerus - Diagnosis - AO Surgery Reference. Retrieved April 25, 2014 . 
4. ^ Charles S. Neer: Displaced proximal humeral fractures. Part I. Classification and evaluation . In: The Journal of Bone & Joint Surgery . tape 52 , no. 6 , September 1970, ISSN  0021-9355 , p. 1077-1089 ( online [accessed April 25, 2014]). online ( Memento of the original from May 4, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
5. ^ Charles S. Neer: Displaced Proximal Humeral Fractures Part II. Treatment of three-part and four-part displacement . In: The Journal of Bone & Joint Surgery . tape 52 , no. 6 , September 1970, ISSN  0021-9355 , p. 1090-1103 ( online [accessed April 25, 2014]). online ( Memento of the original from May 4, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.  
6. ↑ Klaus J. Burkhart, Sven O. Dietz, Leonard Bastian, Ulrich Thelen, Reinhard Hoffmann, Lars P. Müller: Treatment of the proximal humerus fracture in adults . In: Dtsch Arztebl International . tape 110 , no. 35-36 , 2013, pp. 591–597 , doi : 10.3238 / arztebl.2013.0591 ( online ).
7. ↑ Proximal humerus - Diagnosis - AO Surgery Reference. Retrieved April 25, 2014 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !