Instructional Course Lecture   |    
Proximal Humeral Fractures: Internal Fixation
Daniel Aaron, MD1; Joshua Shatsky, MD1; Juan Carlos Paredes, MD2; Chunyun Jiang, MD3; Bradford O. Parsons, MD1; Evan L. Flatow, MD1
1 Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029. E-mail address for E.L. Flatow: Evan.flatow@mountsinai.org
2 St. Luke's Medical Center, 279 East Rodriguez Sr. Boulevard, Quezon City, 1102 Philippines
3 Department of Orthopaedic Surgery, Beijing Ji Shui Tan Hospital, No. 31 Xinjiekoudonggjie Street, Xicheng District, 100035 Beijing, China
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

Look for this and other related articles in Instructional Course Lectures, Volume 62, which will be published by the American Academy of Orthopaedic Surgeons in March 2013:

“Proximal Humeral Fractures: Prosthetic Replacement,” by Daniel Aaron, MD, Bradford O. Parsons, MD, Francois Sirveaux, MD, and Evan L. Flatow, MD

Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2013 in Instructional Course Lectures, Volume 62. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Dec 19;94(24):2280-2288
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Fractures of the proximal part of the humerus represent 4% to 5% of all fractures1,2. Older individuals are more likely to sustain these injuries: 71% of proximal humeral fractures occur in patients over the age of sixty years3,4. As the population ages, such data suggest a potential increase in the total number of proximal humeral fractures. Some authors have estimated a threefold increase in the upcoming thirty years5. Neer asserted that most proximal humeral fractures are minimally displaced or nondisplaced, allowing nonoperative treatment to yield high rates of union and functional restoration6; however, a recent multicenter study noted that 64% were displaced7. Management strategies for displaced fractures have evolved recently because of advances in technology and improved understanding of pathophysiology. Unless contraindications exist, the recommended general strategy for the management of displaced proximal humeral fractures is operative, with use of various forms of internal fixation. These include pins, screws, tension-band wires, plate and screw constructs, heavy sutures, and intramedullary devices. Arthroplasty, which has also undergone dramatic advances in recent years, is an additional option. Each technique has particular indications, and each is subject to its own set of potential complications. Therefore, familiarity with all of these techniques is essential for the practitioner caring for fractures of the proximal part of the humerus.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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