{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T17:18:17Z","timestamp":1767633497182,"version":"3.48.0"},"reference-count":33,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Avascular necrosis (AVN) of the humeral head is a severe complication after intracapsular proximal humerus fractures in the elderly. Hertel\u2019s radiographic classification is widely used to estimate ischemic risk, yet its real-world accuracy remains debated. Methods: We retrospectively analyzed 204 patients aged \u226565 years treated between 2019 and 2022 for intracapsular proximal humerus fractures. Fractures were classified according to Hertel\u2019s criteria and the LEGO system. The incidence of AVN and its association with radiographic predictors were assessed. Diagnostic performance metrics (sensitivity, specificity, predictive values, accuracy) were calculated for Hertel\u2019s classification. Results: AVN developed in 22 patients (10.8%). High-risk fractures according to Hertel\u2019s criteria showed a 24.7% AVN rate versus 0.8% in low-risk fractures (p &lt; 0.001; OR = 38.7). Hertel\u2019s model demonstrated high sensitivity (95.5%) and negative predictive value (99.2%) but low positive predictive value (24.7%). Medial hinge disruption and calcar extension &lt; 8 mm were the strongest radiographic predictors (p &lt; 0.001). Conclusions: Hertel\u2019s classification effectively identifies elderly patients at low risk for AVN, given its high sensitivity and NPV. However, its limited positive predictive value highlights the need for integrative models combining radiographic and clinical parameters to improve ischemic risk stratification.<\/jats:p>","DOI":"10.3390\/jpm16010034","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T12:38:56Z","timestamp":1767616736000},"page":"34","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Can Hertel Criteria Reliably Predict Avascular Necrosis After Intracapsular Proximal Humerus Fractures in the Elderly? A Retrospective Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3058-062X","authenticated-orcid":false,"given":"Marco Simone","family":"Vaccalluzzo","sequence":"first","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-9132","authenticated-orcid":false,"given":"Marco","family":"Sapienza","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Giardina","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0158-1437","authenticated-orcid":false,"given":"Mirko Giuseppe","family":"Sicurella","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Raciti","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1677-927X","authenticated-orcid":false,"given":"Andrea","family":"Vescio","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8066","authenticated-orcid":false,"given":"Vito","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-9714","authenticated-orcid":false,"given":"Gianluca","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2151459320971568","DOI":"10.1177\/2151459320971568","article-title":"High-Energy Proximal Humerus Fractures in Geriatric Patients: A Review","volume":"11","author":"Walters","year":"2020","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_2","unstructured":"Pencle, F.J., and Gossman, W.G. (2023). Proximal Humerus Fracture, StatPearls."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s12178-024-09927-6","article-title":"Osteoporosis Management for Shoulder Surgeons","volume":"17","author":"Healy","year":"2024","journal-title":"Curr. Rev. Musculoskelet. 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