Primary blood supply to humeral head is the ascending (arcuate) branch of anterior humeral circumflex artery which runs in the bicipital groove.(Jaberg, JBJS 74A:508 1992) Less significant supplies include the posterior humeral circumflex artery and small vessels enteriing through the rotator cuff insertions.Displaced greater tuberosity fx is pathognomonic of a longitudinal tear in the rotator cuff at the rotator interval between the supraspinatus and subscapularis tendons.Lesser tuberosity = insertion of subscapularis tendon.Greater tuberosity = insertion of supraspinatus, infraspinatus, and teres minor tendons.The humeral head is retroveted an average of 30 degrees. The neck-shaft inclination angle averages 145 degrees. Normal distance from the greater tuberosity to the superior protion of the articular surface of the humeral head = 7-8mm (Iannotti JP, JBJS 1992 74A:491), (Takase K, JSES 2002 11:557). Mean distance between the pectoralis major tendon and the top of the humeral articular surface is 5.6cm (Murachaovsky J, JSES 2006 15:675). Risk factors: osteoporosis, advance age.60 year old woman has on 8% risk of lifetime proximal humerus fracture (Lauritzen JB, Osteoporos Int 1993 3:127). 15-20% have significant displacement, angulation, malrotation or GT involvement.In young patients they generally involve high-energy trauma. In patients >60years the majority occur from a simple fall.Third most common fracture in patients >60 years of age.Majority occur in the elderly (fracture of senescence), are minimally displaced and stable.Proximal Humerus Fx Etiology / Epidemiology / Natural History 812._9(fracture of humerus, upper end, other head, upper epiphysis).812._3(fracture of humerus, upper end, greater tuberosity).812._2(fracture of humerus, upper end, anatomic neck).812._1(fracture of humerus, upper end, surgical neck).812._0(fracture of humerus, upper end, unspecified).P- subsequent encounter for fracture with malunion K- subsequent encounter for fracture with nonunion G- subsequent encounter for fracture with delayed healing See all Part proximal humerus fracture ICD-10 codes.ĭ- subsequent encounter for fracture with routine healing.S42.209A - Unspecified fracture of upper end of unspecified humerus, initial encounter for closed fracture.S42.202A - Unspecified fracture of upper end of left humerus, initial encounter for closed fracture.S42.201A - Unspecified fracture of upper end of right humerus, initial encounter for closed fracture.Associated Injuries / Differential Diagnosis
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