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Humeral Head/Neck Fracture
Michael J. Tuite, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        TERMINOLOGY

        • Synonyms

          • Surgical neck fracture, proximal humerus fracture
        • Definitions

          • Proximal humerus fx
            • Usually involves surgical neck (metaphyseal fx)
            • Also isolated greater tuberosity fx
          • Humeral head (intracapsular fx)
            • Anatomic neck fx
            • Articular split (head split) fx
            • Also Hills-Sachs impaction fx after dislocation

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Sandstrom CK et al: Acute shoulder trauma: what the surgeon wants to know. Radiographics. 35(2):475-492, 2015
                                      2. Maier D et al: Proximal humeral fracture treatment in adults. J Bone Joint Surg Am. 96(3):251-61, 2014
                                      3. Mutch J et al: A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical implications. Bone Joint J. 96-B(5):646-51, 2014
                                      4. Ramappa AJ et al: Using computed tomography to assess proximal humerus fractures. Am J Orthop (Belle Mead NJ). 43(3):E43-7, 2014
                                      5. Bruinsma WE et al: Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT. J Bone Joint Surg Am. 95(17):1600-4, 2013
                                      6. Cuny C et al: AST classification of proximal humeral fractures: introduction and interobserver reliability assessment. Eur J Orthop Surg Traumatol. 23(1):35-40, 2013
                                      7. Neuhaus V et al: What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture? Clin Orthop Relat Res. 471(5):1698-706, 2013
                                      8. Sukthankar AV et al: A comprehensive classification of proximal humeral fractures: HGLS system. J Shoulder Elbow Surg. 22(7):e1-6, 2013
                                      9. Roux A et al: Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 98(6):715-9, 2012
                                      10. Shrader MW et al: Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg. 14(5):497-505, 2005
                                      11. Bucholz RW et al: Rockwood and Green's Fractures in Adults. Vol 1. 5th ed. Philadelphia: Lippincott Williams & Wilkins. 997-1023, 2001
                                      12. Blake R et al: Emergency department evaluation and treatment of the shoulder and humerus. Emerg Med Clin North Am. 17(4):859-76, vi, 1999
                                      13. Bernstein J et al: Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 78(9):1371-5, 1996
                                      14. Kilcoyne RF et al: The Neer classification of displaced proximal humeral fractures: spectrum of findings on plain radiographs and CT scans. AJR Am J Roentgenol. 154(5):1029-33, 1990
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Pathology

                                            TERMINOLOGY

                                            • Synonyms

                                              • Surgical neck fracture, proximal humerus fracture
                                            • Definitions

                                              • Proximal humerus fx
                                                • Usually involves surgical neck (metaphyseal fx)
                                                • Also isolated greater tuberosity fx
                                              • Humeral head (intracapsular fx)
                                                • Anatomic neck fx
                                                • Articular split (head split) fx
                                                • Also Hills-Sachs impaction fx after dislocation

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • General Features

                                                          • Staging, Grading, & Classification

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Sandstrom CK et al: Acute shoulder trauma: what the surgeon wants to know. Radiographics. 35(2):475-492, 2015
                                                                          2. Maier D et al: Proximal humeral fracture treatment in adults. J Bone Joint Surg Am. 96(3):251-61, 2014
                                                                          3. Mutch J et al: A new morphological classification for greater tuberosity fractures of the proximal humerus: validation and clinical implications. Bone Joint J. 96-B(5):646-51, 2014
                                                                          4. Ramappa AJ et al: Using computed tomography to assess proximal humerus fractures. Am J Orthop (Belle Mead NJ). 43(3):E43-7, 2014
                                                                          5. Bruinsma WE et al: Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT. J Bone Joint Surg Am. 95(17):1600-4, 2013
                                                                          6. Cuny C et al: AST classification of proximal humeral fractures: introduction and interobserver reliability assessment. Eur J Orthop Surg Traumatol. 23(1):35-40, 2013
                                                                          7. Neuhaus V et al: What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture? Clin Orthop Relat Res. 471(5):1698-706, 2013
                                                                          8. Sukthankar AV et al: A comprehensive classification of proximal humeral fractures: HGLS system. J Shoulder Elbow Surg. 22(7):e1-6, 2013
                                                                          9. Roux A et al: Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 98(6):715-9, 2012
                                                                          10. Shrader MW et al: Understanding proximal humerus fractures: image analysis, classification, and treatment. J Shoulder Elbow Surg. 14(5):497-505, 2005
                                                                          11. Bucholz RW et al: Rockwood and Green's Fractures in Adults. Vol 1. 5th ed. Philadelphia: Lippincott Williams & Wilkins. 997-1023, 2001
                                                                          12. Blake R et al: Emergency department evaluation and treatment of the shoulder and humerus. Emerg Med Clin North Am. 17(4):859-76, vi, 1999
                                                                          13. Bernstein J et al: Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 78(9):1371-5, 1996
                                                                          14. Kilcoyne RF et al: The Neer classification of displaced proximal humeral fractures: spectrum of findings on plain radiographs and CT scans. AJR Am J Roentgenol. 154(5):1029-33, 1990