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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.

The articular surface of the proximal humerus approximates the hemisphere and it is referred to 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 can be 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.  The blood supply to the humeral head may be interrupted in certain injuries, 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 and may be treated without operative intervention.

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

Fractures of the proximal humerus are important because of the increasing incidence of these injuries in populations with poor bone quality, such as 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 and can 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, partial joint replacement has been used for fractures that cannot be repaired with plates and screws.  Unfortunately, the functional outcomes of fractures patients after joint replacement are often mediocre and deteriorate with time.

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.  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 can increase the pull out strength of the main screw by as much as 50%.

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.

Contact Us

Toby Orthopaedics, Inc.

Domestic Toll-free:
866.979.TOBY (8629)
Office: 305.665.8699
Fax: 305.768.0269