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Proximal Humerus Fracture Repair

Shoulder fractures are one of the most common injuries, accounting for roughly 5.7% of all fractures and occurring in .049% of the population.

The humerus is the largest bone in the upper extremity.  The proximal humerus relates to the upper part of the humerus that articulates with the scapula, comprising the shoulder joint. Proximal humerus fracture repair, therefore, is a very common problem for many people.

The articular surface of the proximal humerus approximates the hemisphere. This is known as the humeral head.  Three identifiable columns that blend into the long shaft, or diaphysis, of the bone, support the humeral head.

The muscles about the shoulder are divided into a deep set of muscles, referred to as the rotator cuff, and a more superficial set of muscles, such as the deltoid and the pectoralis.  The muscles of the rotator cuff insert into the proximal humerus at prominences known as tuberosities and are key to the proper functioning of the shoulder joint.  The large muscle that envelops the shoulder joint is the deltoid.  Certain injuries can interrupt the blood supply to the humeral head, leading to bone infarction or avascular necrosis.

The bone infarct or avascular necrosis of the humeral head may be only partial, such that the bone may recover and heal uneventfully.

The patterns of fractures about the proximal end of the humerus have been classified according to American surgeon Charles Neer in 1971 into two, three and four-part fractures depending on how many fragments resulted from the injury.  The majority of fractures are minimally displaced. Hence, operative intervention does not need to feature in the treatment of such a fracture.

Proximal Humerus Fracture Repair Goals

The goal of surgical treatment is to achieve anatomic realignment of the fracture fragments, or fracture reduction. It also aims to stabilize them sufficiently such that rehabilitation can begin soon after surgery.

Fractures of the proximal humerus are important because of their increasing incidence in populations with poor bone quality. An example of this is the Western world’s aging citizenry with weaker, osteoporotic bone.

Many patients with weaker, osteoporotic bone experience failures with traditional plating systems.  Often, the screws will cut through the soft bone over time, protruding into the joint.  This painful experience results in a loss of fixation. It can also mean either a second plating surgery or a partial or total shoulder replacement.

An alternative to plating proximal humerus fractures is the partial or total replacement of the shoulder joint.  Historically, treatment for fractures where plates or screws are not effective has meant partial joint replacement.  Unfortunately, the functional outcomes of fractures patients after joint replacement are often mediocre and deteriorate with time.

Proximal Humerus Fracture Repair, With TOBY Orthopaedic

PANTERA® represents the next generation of plating technology.  Inspired by the high incidence of joint penetration, particularly in elderly patients with osteopenic bone, TOBY technology now makes it possible for surgeons to apply a screw or peg through a locking post, thus accomplishing an internal scaffold within the patient’s bone.

Furthermore, this unique, patented Cross Element design minimizes loss of reduction and screw protrusion through the articular surface of the humeral head.  Each of the small 2.0mm Cross Element screws increases the pullout strength of the main screw by as much as 50%.

Finally, keep in mind that only your doctor can advise you on your specific needs.  However, if you have weak or osteoporotic bone, or if you have a complicated injury, the PANTERA® system may provide superior options for surgical fixation of your own bone and help avoid a costly and painful (partial or total) shoulder replacement.  We encourage you to speak with your doctor about all options you feel might be right for you.