Evolution of Treatment of Proximal Humerus Impacted Valgus Fractures

Introduction: Impacted valgus fractures of proximal humerus commonly result from low energy applied to an osteoporotic bone such as in simple falls. The incidence is increasing parallel to population aging. As these fractures carry specific anatomic considerations, recognition of this fracture type and implementation of universal principles is special type of fracture. It is an uncommon fracture but important injury to recognize in patients with orthopedic trauma. Understanding the patho-anatomy and recognizing this fracture is essential in order to provide appropriate care.

Humeral impacted valgus fracture was described in 1976 by Dupar and Largier. Until 1982 arthroplasty was the treatment of choice due to the fracture complexity and the unacceptable outcome of both surgical and non-surgical treatments. In 1991 Jakob wrote in favor of lifting the humeral head from its valgus to an anatomic position. At that time he could only use screws and Kirchner wires for fixation. With this technique he reported satisfactory outcome in 72% of cases. Uncertainty surrounding treatment approach was later demonstrated when four renowned orthopedic shoulder specialists published in 2006 their expert opinion stating that “Surgeons must use an individualized approach for each patient with this fracture”.

We present two demonstrative cases of impacted valgus fractures of the proximal humerus treated in our department 25 years apart, before and after the advances described above.

Conclusion: Understanding the unique anatomic considerations and the development of advanced instrumentation and implants facilitated the evolution of treatment of impacted valgus fractures of the proximal humerus. Current management based on these advances commonly results in excellent clinical and radiological outcome.