{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:13:00Z","timestamp":1790997180086,"version":"4.1.0"},"reference-count":21,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"3","license":[{"start":{"date-parts":[[2011,3,1]],"date-time":"2011-03-01T00:00:00Z","timestamp":1298937600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:p>Our aim was to determine the effect of the initial pattern of fracture and the displacement of fragments on the outcome of proximal humeral fractures treated conservatively. We followed 93 consecutive patients prospectively for one year. Final movement and strength were compared with those of the contralateral side. The final American Shoulder and Elbow Society score and the Disabilities of Arm, Shoulder and Hand and Short-Form 36 questionnaires were compared with those provided by the patient on the day of the injury. Radiographs and CT scans with three-dimensional reconstruction were obtained in all patients. The pattern of the fracture and the displacement of individual fragments were analysed and correlated with the final outcome. There were two cases of nonunion and six of avascular necrosis. The majority of the fractures (84 patients; 90%) followed one of the following four patterns: posteromedial (varus) impaction in 50 patients (54%), lateral (valgus) impaction in 13 (14%), isolated greater tuberosity in 15 (16%), and anteromedial impaction fracture in six (6%). Head orientation, impaction of the surgical neck and displacement of the tuberosity correlated strongly with the outcome.<\/jats:p>\n                  <jats:p>In fractures with posteromedial impaction, a poor outcome was noted as the articular surface displaced inferiorly increasing its distance from the acromion. A poorer outcome was noted as a fractured greater tuberosity displaced medially overlapping with the posterior articular surface. Lateral impaction fractures had a worse outcome than other patterns of fracture.<\/jats:p>","DOI":"10.1302\/0301-620x.93b3.25083","type":"journal-article","created":{"date-parts":[[2011,3,1]],"date-time":"2011-03-01T17:09:34Z","timestamp":1298999374000},"page":"378-386","source":"Crossref","is-referenced-by-count":91,"title":["The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures"],"prefix":"10.1302","volume":"93-B","author":[{"given":"A. M.","family":"Foruria","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Fundaci\u00f2n Jim\u00e9nez D\u00edaz-Capio, Avda Reyes Cat\u00f2licos 2, Madrid 28040, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"de Gracia","sequence":"additional","affiliation":[{"name":"Department of Radiology, La Paz University Hospital, P\u00b0 de la Castellana 261, Madrid 28036, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. R.","family":"Larson","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Statistics and Infomatics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Munuera","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f2noma de Madrid, Arzobispo Morcillo 2, Madrid 28029, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Sanchez-Sotelo","sequence":"additional","affiliation":[{"name":"Mayo Clinic, 200 First Street S. W., Rochester, Minnesota 55905, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","doi-asserted-by":"crossref","unstructured":"Neer CS 2nd.\n                      Displaced proximal humeral fractures. I: classification and evaluation. 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J Bone Joint Surg [Am] 1984;66-A:899\u2013906.","DOI":"10.2106\/00004623-198466060-00010"},{"key":"R13","doi-asserted-by":"crossref","unstructured":"M\u00fcller ME, Nazarian S, Koch P.\n                      Classification of AO des fractures\n                      . Vol. 1. Berlin: Springer-Verlag, 1987 (in French).","DOI":"10.1007\/978-3-662-06263-0_1"},{"key":"R14","unstructured":"Codman EA.\n                      Fractures in relation to the subacromial bursa. In:\n                      The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa\n                      . Vol. 1. 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