anapath of proximal humerus fractures.pptx

MECANISM AND CLASSIFICATIONS OF ESH FRACTURES

1. Service orthopedie a pr benhabiles PRESENTED BY DR AGGOUN ANAPATH of proximal humerus fractures

2. plan INTRODUCTION DIAGNOSTIC MECHANISM CLASSIFICATIONS CHOOSING THE CLASSIFICATION TREATEMENT CONCLUSION

3. INTRODUCTION Proximal humerus fractures are common injuries, especially in older adults. They can occur as a result of falls, motor vehicle accidents, and other types of trauma. Understanding the different classifications of these fractures is important for choosing the best course of treatment.

4. diagnostic History :   the mechanism of injury, symptoms , and medical history. Physical examination: Severe pain in the shoulder , Swelling and bruising of the shoulder , Deformity of the shoulder , Inability to move the arm ;Numbness or tingling in the arm  

5. diagnostic Imaging tests: X-rays:  the most important imaging test for diagnosing proximal humerus fractures CT scan:  if we needs more information about the fracture. MRI scan:  used to assess the soft tissues around the fracture

6. ANAPATH MECHANISM CLASSIFICATIONS

7. mechanism Direct or Indirect low-energy falls elderly with osteoporotic bone high-energy trauma(direct trauma) young individuals concomitant soft tissue and neurovascular injuries

8. classifications EARLY CLASSIFICATIONS: Codman (1934 ) Neer ( 1970) MODERN CLASSIFICATIONS: AO/OTA ( 1980s ) Codman- Hertel (2004): Resch ( 2016) MAYO FJD (2020)

9. codman Based on four anatomic parts (humeral shaft, articular surface, greater tuberosity, and lesser tuberosity) but did not consider displacement.

10. NEER The most commonly used classification The basis of the system according to Displacement Anatomical lines of epiphyseal union

11. Neer considered a separate part if displacement of > 1 cm 45° angulation

12. Modified neer classification Group I: Minimally displaced fractures (one-part and some two-part fractures) Group II: Displaced anatomic neck fractures Group III: Displaced surgical neck fractures Group IV: Displaced greater tuberosity fractures Group V: Displaced lesser tuberosity fractures Group VI: Fracture-dislocation

13. advantageS Has ability to separate PHF into broad categories, which are intuitively understood and which have important differences . widely used by surgeons because, at least broadly speaking, it has been found useful to guide treatment, anticipate prognosis, and group similar fracture patterns for research purposes. The classification system also is pedagogically useful for orthopaedic trainees in that it helps explain how the deforming forces around the joint cause the observed patterns of fracture displacement.

14. LIMITATIONS including limited ability to distinguish among the many patterns of one-part fractures does not incorporate several variables such as the length of the metaphyseal hinge, magnitude of initial displacement, and varus displacement that predict clinical outcome scores.

15. AO/OTA Based on articular surface involvement, anatomic location, and dislocation. Divides fractures into three main types with further subdivisions. Identifies valgus impaction of the proximal humeral neck . Complete and complex

16. Codman -Hertel Binary system based on fracture morphology and predictors of fracture-induced humeral head ischemia. Uses structured questionnaires to categorize fractures into 12 types.

17. Resch Similar scheme focusing on valgus vs varus impacted fractures.

18. MAYO FJD It is a newer system that has been shown to be reliable and easy to use. It divides proximal humerus fractures into seven main types based on the fracture pattern.

19. Choosing the classification Choosing the right classification system depends on the patient's age, medical history, and the severity of the fracture. that Codman- Hertel had the highest reliability , followed by Neer , then Resch , and finally AO/OTA The Neer classification is a good choice for simple, undisplaced fractures. The AO/OTA classification is a good choice for more complex fractures. The Mayo-FJD classification may be a good choice for all types of proximal humerus fractures.

20. The treatment The treatment of proximal humerus fractures depends on the specific classification of the fracture. Non-surgical treatment may be an option for some fractures, such as undisplaced 1-part fractures. However, most proximal humerus fractures require surgery. variety of surgical techniques that can be used The most common type of surgery is internal fixation

21. conclusion Proximal humerus fractures are a common injury that can be caused by a variety of factors. There are several different ways to classify these fractures Other classifications: Habermeyer and Schweiberer ,and Gerber Despite its limitation neer is still the most used one the treatment and prognosis will vary depending on the specific classification .

22. references Management of Proximal Humerus Fractures in Adults —A Scoping Review Hayden P. Baker , *   Joseph Gutbrod ,  Jason A. Strelzow ,  Nicholas H. Maassen , and  Lewis Shi * Alexandre Lädermann ,  Academic Editor and J. Christoph Katthagen ,  Academic Editor Classification of proximal humerus fractures according to pattern recognition is associated with high intraobserver and interobserver agreement panelAntonio M. Foruria MD, PhD a, Natalia Martinez-Catalan MD a, Belen Pardos MD a, Dirk Larson MS b, Jonathan Barlow MD, MS c, Joaquín Sanchez- Sotelo MD, PhD 2022 imaging to improve agreement for proximal humeral fracture classification in adult patient: a systematic review of quantitative studies J Clin orthopaedics Trauma, 11 (2020), pp. S16-S24, 10.1016/j.jcot.2019.06.019 Kilcoyne , R. F., et al. (1990). “The Neer classification of displaced proximal humeral fractures: spectrum of findings on plain radiographs and CT scans . https://radiopaedia.org/articles/neer-classification-of-proximal-humeral-fractures-1#:~:text=The%20Neer%20classification%20of%20proximal,reports%20of%20proximal%20humeral%20fractures.

23. Thank you