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  • Title: [Fractures of the humeral head. Conservative and surgical differential therapy].
    Author: Habermeyer P, Schweiberer L.
    Journal: Unfallchirurg; 1991 Sep; 94(9):438-46. PubMed ID: 1948103.
    Abstract:
    The Neer classification for fractures of the proximal humerus is a system based on accurate identification of the four major fragments and their relationship to each other. There is a specific type of displaced 4-fragment fracture of the proximal humerus which consists in valgus impaction of the head fragment. This type of fracture is combined with a lower rate of avascular necrosis than that of other displaced 4-fragment fractures. In addition, the outcome is different according to whether a displaced 4-fragment fracture affects the surgical or the anatomical neck. Those through the surgical neck have a much lower rate of avascular necrosis than those through the anatomical neck. Therefore, 4-fragment valgus impacted fractures through the surgical neck should be treated by open reduction and internal fixation rather than by primary hemiarthroplasty in younger patients.
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