Abstract
We reviewed 661 proximal humeral fractures registered to the JSS database to clarify the incidence, nature and treatment of valgus impacted fractures. Three shoulder experts from Matsudo Orthopaedic Hospital, Nippon Medical School and Dokkyo Medical University independently classified all the registered fractures according to the Neer classification (1970), and picked up possible valgus impacted fractures (N=71, 11%) according to the description of Jakob (1984, 1991). Disagreement of the classification among the 3 reviewers (226 / 661 cases) was discussed, and additional criteria for valgus impacted fractures (Neer 2002, Robinson 2003) were referred to. Reassessment, again performed independently by the same reviewers, revealed 19 (3%) valgus impacted fractures. Of these, 3 were treated conservatively, 10 by osteosynthesis, and 6 by hemiarthroplasty. The active shoulder elevation at the follow-up was generally good in patients who underwent osteosynthesis, whereas poor in those who had been treated conservatively. The authors conclude that (i) valgus impacted fractures consist of 3-11% of proximal humeral fractures, (ii) the 2002 Neer classification which categorized this type of fracture is a better option for clinical use, and (iii) valgus impacted fractures should be treated by osteosynthesis with care not to insult the blood supply to the humeral head through the medial periosteum.
