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Open treatment proximal humeral fracture

A humerus fracture can be classified by the location of the humerus involved: the upper end, the shaft, or the lower end. Certain lesions are commonly associated with fractures to specific areas of the humerus. At the upper end, the surgical neck of the humerus[1] and anatomical neck of humerus[2] can both be involved, though fractures of the surgical neck are more common. The axillary nerve can be damaged in fractures of this type. Mid-shaft fractures may damage the radial nerve, which traverses the lateral aspect of the humerus closely associated with the radial groove. The median nerve is vulnerable to damage in the supracondylar area, and the ulnar nerve is vulnerable near the medial epicondyle, around which it curves to enter the forearm. Radiographs are usually considered as a first-line imaging modality to evaluate clinically suspected humerus fracture. US, MRI, and CT are adequate alternatives if radiographs fail to demonstrate the cause of symptoms or do not sufficiently delineate the fracture for management purposes. CT is currently considered the gold standard to diagnose, but has limitations to detect adjacent soft tissue disorders. Depiction of greater tuberosity fractures at US is not uncommon in trauma setting because the fracture may be missed or overlooked at baseline radiographs and the patient will then present for US to scan rotator cuff for abnormalities.[3]



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