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Selected Instructional Course Lecture   |    
Arthroplasty for Fractures of the Proximal Part of the Humerus
James E. Voos, MD1; Joshua S. Dines, MD1; David M. Dines, MD1
1 Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for J.S. Dines: dinesj@hss.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Biomet).

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
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 February 2011 in Instructional Course Lectures, Volume 60. 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).

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jun 01;92(6):1560-1567
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Extract

Proximal humeral fractures represent nearly 50% of all shoulder girdle injuries, and the incidence has been increasing in the elderly population in recent decades1-4. Overall, proximal humeral fractures account for 4% to 5% of all fractures5. The majority occur in women as the result of a low-impact fall, although high-velocity trauma is often involved in younger patients1,6. Most proximal humeral fractures are either nondisplaced or minimally displaced and do not need surgical treatment7,8. Treatment of displaced fractures presents a more difficult challenge. Complex displaced three and four-part fractures, fracture-dislocations, and fractures with a humeral head split are at risk for the development of malunion and osteonecrosis, especially after internal fixation9-12. Shoulder hemiarthroplasty or, recently, reverse total shoulder arthroplasty is indicated for the treatment of some of these complex fractures. Strict attention to preoperative planning and surgical technique are paramount for a successful outcome and to avoid complications.
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    Accreditation Statement
    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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