QUIZZ
2/3/4 Parts
Plate High/Low
AVN Risk 1
AVN Risk 2
Delayed healing
True AP
Protruding Screw
Step by Step

DESCRIPTION AND UNDERSTANDING OF PROXIMAL HUMERUS FRACTURES
USING 3D COLOURED MODELS

DESCRIPTION

11-XX-400 / 75y / Right hemiplegia

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

3 PARTS FRACTURE

The red fragment includes the bicipital groove and most of the greater. The red fragment is tilted in varus and posteriorly. It is shifted back respect to the shaft.

The blue fragment includes the medial part of the lesser, and part of the joint surface. The blue fragment impinges on the anterior border of the glenoid.

There is a step at the joint between the red and the blue fragments.

The upper part of the shaft fragment protrudes anterior and medially.

Low AVN Risk

11-XX-321 / 65y

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

4 PARTS FRACTURE

The red fragment is very small, includes just the joint surface. The red fragment is 100% posteriorly shifted respect to the shaft.

The orange fragment is multifragmentary. Only a minor step between the orange and the red fragment.

The blue fragment (2-part fragment, different shades of blue) includes whole of the lesser, the bicipital groove and a large part of the joint surface.

Important step between the blue and red fragment.

High AVN Risk

11-EA-747 / 60y

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

2 PARTS FRACTURE

The red fragment includes the bicipital groove and most of the greater. The red fragment is tilted in varus and posteriorly. It is shifted back respect to the shaft.

The blue fragment includes the medial part of the lesser, and part of the joint surface. The blue fragment impinges on the anterior border of the glenoid.

There is a step at the joint between the red and the blue fragments.

The upper part of the shaft fragment protrudes anterior and medially.

Low AVN Risk

11-XX-886 / 70y

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

3 PARTS FRACTURE

Red fragment Includes lesser, bicipital groove and half of the greater.

The red fragment is nested into the shaft.

The orange includes posterior part of the greater and is comminuted

Low AVN Risk

11-XX-720

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

3 PARTS FRACTURE

The greater and the lateral half of the lesser are a single large fragment (blue) extended to the shaft, including 1/3 of the joint surface (split head?).
The red fragment includes the medial half of the lesser and extends to the shaft
Large step-off at the joint.
Important shortening 
Low AVN risk.

11-VI-229

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

3 PARTS FRACTURE

2/3 of the greater are the posterior fragment (orange). It includes just an edge of the joint surface.
The red fragment includes the head, the lesser and the anterior 1/3 of the greater.
Large step-off at the joint.
The red fragment is displaced in valgus and strongly tilted posteriorly.
Low AVN risk.

11-VI-284

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

4 PARTS FRACTURE

3/4 of the greater are the posterior fragment (orange). It includes the lateral edge of the joint.
The anterior 1/4 of the greater, the bicipital groove and the lesser are the anterior fragment (blue). It includes a large part of the joint surface (split head). No glenoid impingement. 
The red fragment is displaced in valgus and nested into the shaft.
Small step-off (orange/red, and blue/red).
High AVN risk.

11-VD-707

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

4 PARTS FRACTURE

3/4 of the greater are the posterior fragment (orange). It includes part of the joint surface. The orange fragment is posteriorly displaced, overlapping the red fragment. Large step-off at the joint.
The anterior 1/4 of the greater, the bicipital groove and the lesser are the anterior fragment (blue).
It includes a large part of the joint surface (split head). No glenoid impingement. Minimal step-off (blue/red). 
The red fragment is displaced in varus and posteriorly.

11-VI-538

2 / 3 / 4 PARTS

GREATER / POSTERIOR (ORANGE)

LESSER / ANTERIOR (BLUE) - IMPINGEMENT

SPLIT HEAD / JOINT SURFACE

DISPLACEMENT / STEP OFF / HEAD SHIFT-TILT (RED)

AVN RISK

4 PARTS FRACTURE

3/4 of the greater are the posterior fragment (orange).
It includes a minimal part of the joint surface.
The anterior 1/4 of the greater, the bicipital groove and the lesser are the anterior fragment (blue).
It includes a large part of the joint surface (split head). No glenoid impingement. Minimal step-off (blue/red).
Minimal step-off (blue/red, and orange /red).
The red fragment is displaced in valgus and nested into the shaft.
High AVN risk