![]() For example, in some cases, the articular surface is facing posteroinferiorly (varus), but there is lack of contact between the humeral shaft and the proximal humerus on all radiographic projections. Avascular necrosis is also seen more frequently in this fracture pattern when treated nonsurgicallyĮven through our pattern-based classification provided almost perfect intraobserver agreement and substantial interobserver agreement, most of the disagreement involved fractures in which there was some degree of varus or VL orientation of the articular surface along with severe displacement of the head in reference to the diaphysis, sometimes to the extreme of complete lack of head-to-shaft contact. The medial periosteal hinge can be preserved or disrupted when disrupted, there is an additional level of instability, which may increase the chances of malunion or even nonunion. The main potential adverse outcome with nonoperative treatment of VL fractures is malunion. The LT may be intact or also fractured (VL-GT-LT). In this fracture pattern, the grater tuberosity is almost always fractured (VL-GT) and pushed laterally by the displaced humeral head. Due to this VL displacement, the lateral aspect of the articular surface is inferior compared to its anatomic position. As such, the head faces superiorly or superolaterally. Similar to the VPM fracture, the plane that separates the humeral head from the diaphysis is also located at the head-neck junction medially and at the metaphysis laterally, but the head is displaced in valgus (VL) in reference to the shaft, and comminution occurs laterally as opposed to posteromedially. American Society of Shoulder and Elbow Therapists.International Congress of Shoulder and Elbow Surgery.Shoulder and Elbow Society of Australia.South African Shoulder and Elbow Surgeons.European Society for Surgery of the Shoulder and Elbow.
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