They used the AO/ASIF classification and reported that they had 16 patients in 11C2.2 and three in 11C2.1, who were all treated surgically. 1 They defined them as four-fragment fractures with varying displacement of the tuberosities and valgus impaction of the humeral head. 7 considered valgus impacted fractures of the proximal humerus to be a specific type of fracture that was not mentioned initially in Neer's classification. 1, 2, 3, 6, 7, 8 These characteristic factors may lead to a higher consolidation rate for these fractures, compared with other complex fractures of the proximal humerus. 11 Maintenance of this medial hinge may also help in fracture reduction, since it serves as a support point (fulcrum) for the humeral head to return to its varus position, without losing contact with the metaphyseal region of the diaphysis. The incidence of this complication is 21–75% in four-part fractures and 8–26% in situations of valgus impact. 1, 2, 3, 6, 8, 9, 10, 11, 12, 13 This may give rise to avoidance of the most frequent complication of complex fractures of the proximal humerus: avascular necrosis. The blood supply to the humeral head may be preserved ( Fig. Consequently, the posterior humeral circumflex artery (which passes through this region) may also be maintained. 1, 2, 8, 10, 12 In this specific type of fracture, with metaphyseal bone impaction, the posteromedial periosteum of the humeral head (i.e. The mechanism for these fractures consists of axial trauma to the abducted upper limb, with direct impaction between the humeral head and the glenoid cavity, and consequent impaction and posteromedial displacement (dorsal tilting of the head) because of its physiological anatomical conformation in retroversion. These fractures have received attention that differentiates them from other complex fractures of the proximal humerus, because of their better prognosis with regard to surgical reduction, consolidation and occurrences of avascular necrosis. the angle between the anatomical neck and the axis of the humeral diaphysis. Radiograph showing measurement of the cervicodiaphyseal angle of the proximal humerus, i.e.
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