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Related Concept Videos

Fractures: Bone Repair01:27

Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Bones of the Upper Limb: Humerus01:19

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Related Experiment Video

Updated: Oct 1, 2025

Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
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Protective and Risk Factors for Humerus Head Necrosis After Proximal Humerus Fracture Treated with Internal Locking

Tomas Da Silva1, David-Benjamin Ehrhard1, Theo Manuel Chuchuy1

  • 1Department of Trauma Surgery and Orthopedics, Klinikum Stuttgart - Katharinenhospital, Kriegsbergstraße 60, 70174 Stuttgart, Germany.

Indian Journal of Orthopaedics
|March 7, 2022
PubMed
Summary

Proximal humerus fractures (PHF) can lead to humerus head necrosis (HHN). Fracture complexity and medial hinge displacement are key risk factors, but perfect reduction significantly prevents HHN.

Keywords:
Humerus head necrosisMetaphyseal head extensionPerfect reductionProtective factorsProximal humerus fracturesRisk factorsSurgery timing

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Orthopedic Robot-Assisted Femoral Neck System in the Treatment of Femoral Neck Fracture
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Area of Science:

  • Orthopedic surgery
  • Traumatology
  • Bone healing

Background:

  • Proximal humerus fractures (PHF) are common orthopedic injuries.
  • Post-traumatic humerus head necrosis (HHN) occurs in 3-35% of cases after ORIF with internal locking plates.
  • Risk factors for HHN, including Hertel's criteria, require further investigation.

Purpose of the Study:

  • To identify risk factors for humerus head necrosis (HHN) following proximal humerus fracture (PHF) treatment.
  • To evaluate the impact of fracture characteristics and surgical reduction quality on HHN development.
  • To assess the correlation between surgical timing and HHN incidence.

Main Methods:

  • A 10-year retrospective cohort study of 305 patients treated with a PHILOS plate.
  • Analysis of fracture type (AO/Neer), neck-shaft angle (NSA), metaphyseal head extension (MHE), and medial hinge displacement (MHD).
  • Primary endpoint was the diagnosis of humerus head necrosis (HHN).

Main Results:

  • HHN occurred in 4% of patients, primarily within the first year post-surgery.
  • Significant correlations found between HHN and fracture complexity, initial NSA, and MHE.
  • Medial hinge displacement (MHD) was present in all HHN cases; perfect reduction (<2 mm dislocation) prevented HHN (0%).

Conclusions:

  • Fracture complexity and medial hinge disruption with short metaphyseal head extension (<8 mm) are significant risk factors for HHN.
  • Achieving perfect reduction is a critical protective factor, completely avoiding HHN in high-risk cases.
  • Surgical timing does not appear to influence the development of HHN.