Four Part Humeral Fracture Wheeless

Description: 4 Part fracture of the proximal humerus/neck of humerus
- Discussion:
- 4 segment frx is most difficult to treat & is assoc w/ poorest results;
- added to problems of three part frx, namely delayed union or non union, is avascular necrosis of the humeral head;
- the classic teaching is that the fragment is devoid of all soft tissue, making AVN certainty, irrespective of treatment;
- as noted by Darder et al 1993, only 9 of 35 patients w/ four part frxs developed AVN, and further, the results were satisfactory or better in 21/35 patients;
- pathognomic feature is the small, crescentic, proximal articular fragment severed from the antatomic neck of the humerus