The fracture is usually evident as a lucency and cortical breach with variable degrees of angulation, impaction and displacement. Regardless of the imaging performed, the number of displaced fragments should be assessed, to enable appropriate classification of the fracture ( Neer classification or AO classification are most commonly used). Additionally, CT (and especially 3D surface shaded reconstructions) has been shown to improve interobserver agreement on classification of proximal humeral fractures 4. CT can be useful if adequate views cannot be obtained, if fractures are unusual or if other fractures (e.g. Plain films are usually sufficient to characterize proximal humeral fractures, and thus to determine management. These forces may be compressive, tension, torsion or bending. Proximal humeral fractures usually result from a fall on an outstretched arm. Indirect forces transmitted through the proximal humerus and shoulder are the cause of most fractures. However, patients may present following a seizure, electrical shock or following direct trauma. Younger patients usually present following a high-trauma incident, e.g. Many older patients present following a relatively innocuous fall. Most of these (90%) occur at home due to a fall, and in most cases they are an isolated injury 1. The majority of proximal humeral fractures occur in the elderly (mean age 65 years) with ~70% occurring in women, presumably due to the greater incidence of osteoporosis 1. As with other injuries, there is a bimodal distribution with a small peak amongst the young. They are most common in older populations and especially in those who are osteoporotic. Proximal humeral fractures represent around 5% of all fractures ?.
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