The impacted varus (A2.2) proximal humeral fracture: prediction of outcome and results of nonoperative treatment in 99 patients.
ABSTRACT BACKGROUND AND PATIENTS: The outcome of the impacted varus proximal humeral fracture has not been described. We present the results of a prospective analysis of 99 such fractures. RESULTS: This fracture was relatively common in the elderly population and non-operative treatment sometimes resulted in increased varus angulation. Decreased shoulder function was associated with increasing age but not with increasing varus angulation. After nonoperative management the outcome was good, regardless of the degree of varus, 1 year after fracture. Age was the main predictor of outcome. Physiotherapy did not improve outcome.
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ABSTRACT: Most proximal humeral fractures are stable injuries of the ageing population, and can be successfully treated non-operatively. The management of the smaller number of more complex displaced fractures is more controversial and new fixation techniques have greatly increased the range of fractures that may benefit from surgery. This article explores current concepts in the classification and clinical aspects of these injuries, reviewing the indications, innovations and outcomes for the most common methods of treatment. Fractures of the proximal humerus account for 5% of injuries to the appendicular skeleton. 1,2 Most are stable, minimally-displaced osteo-porotic fractures in the elderly, and are the result of low-energy falls. 3 Most patients with these injuries will regain a functional shoulder with-out operation. Surgery should only be consid-ered in approximately 20% of patients, 4 either because they require better shoulder function or because their fracture is more complex. An ever-expanding range of reconstructive options has become available to treat these injuries, each with its advantages and disadvantages.J Bone Joint Surg [Br]. 01/2011; 93:1-11.
Article: The Plate-Joystick technique to reduce proximal humeral fractures and nonunions with a varus deformity through the extended deltoid-splitting approach.[show abstract] [hide abstract]
ABSTRACT: Fractures and nonunions in which there is a varus deformity of the humeral head producing posterinferior subluxation of the articular surface are increasingly recognized as an important subgroup of proximal humeral fractures. Operative open reduction and internal fixation of these injuries is often recommended when the varus deformity is severe. We describe a simple technique to assist in the open reduction and locking plate stabilization of this challenging and complex fracture subtype using tools and implants that are readily available in most modern orthopaedic trauma operating rooms.Journal of orthopaedic trauma 07/2011; 25(10):634-40. · 1.78 Impact Factor