M.E.Müller: Atlas: Fracture 11-B2

Humerus, Proximal,
extra-articular fracture, bifocal,
without metaphyseal impaction 0,46% of the total
6,41% of the humerus
15,65% of the segment

97 fractures
38,6% group
27%M, 73%F

87 fractures
34,7% group
29%M, 71%F

67 fractures
26,7% group
46%M, 54%F

Without rotatory displacement of the epiphyseal fragment +Q With rotatory displacement of the epiphyseal fragment Multifragment + one of the tuberosities +Q

These are fractures of the proximal humerus, extra-articular, bifocal, simultaneously involving the metaphysis and the tuberosities. The groups B1 and B2 are determined by whether there is impaction of the metaphysis or not, while the association of a gleno-humeral dislocation marks the group B3. The subgroups are determined by the combination of fractures, of the metaphysis and both tuberosities, and by the possible displacements of the fragments. Ref. Manual of Internal Fixation:
438 - 441.
Surgeon. RO.

For this type of fractures, the same as for the type A, the majority of the surgeons prefer the conservative treatment because the surgical treatment is complex, anatomic reductions are difficult and the metallic internal fixations, when plates are used, interfere with the gliding surfaces.

The fragments of the tuberosities can be grouped together with wires or with non-resorbable suture loops,

obtaining enough stability during the callus formation, usually a fast process in this area. Reattachment of the rotator cuff is the most important surgical step in these cases.

In older patients, not necessarily elderly with unreconstructible fractures (some B2 and B3), partial joint replacement is being indicated with increasing frequency.

preoperative postoperative + 1 year

preoperative + 4 months

. .
Surgeon. LO.

,

.

preoperative

preoperative preoperative

preoperative preoperative

+ 2 months + 2 months




						Humerus, Proximal, extra-articular fracture, bifocal, without metaphyseal impaction	0,46% of the total 6,41% of the humerus 15,65% of the segment






These are fractures of the proximal humerus, extra-articular, bifocal, simultaneously involving the metaphysis and the tuberosities. The groups B1 and B2 are determined by whether there is impaction of the metaphysis or not, while the association of a gleno-humeral dislocation marks the group B3. The subgroups are determined by the combination of fractures, of the metaphysis and both tuberosities, and by the possible displacements of the fragments.		Ref. Manual of Internal Fixation: 438 - 441. Surgeon. RO.

For this type of fractures, the same as for the type A, the majority of the surgeons prefer the conservative treatment because the surgical treatment is complex, anatomic reductions are difficult and the metallic internal fixations, when plates are used, interfere with the gliding surfaces. The fragments of the tuberosities can be grouped together with wires or with non-resorbable suture loops,	obtaining enough stability during the callus formation, usually a fast process in this area. Reattachment of the rotator cuff is the most important surgical step in these cases. In older patients, not necessarily elderly with unreconstructible fractures (some B2 and B3), partial joint replacement is being indicated with increasing frequency.