Management of Proximal Humeral Fractures in the Nineteenth Century: An Historical Review of Preradiographic Sources

Abstract

Background The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed. Questions/purposes I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus. Methods A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search. Results Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years. Conclusions The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Reverse Shoulder Arthroplasty for Proximal Humerus Fracture

“…Treatment in the nineteenth century was hallmarked by the Hippocratic method of reduction followed by bandaging and delayed splinting. In the twentieth century, further surgical and anesthetic advancements sparked attempts at ORIF [26]. The first documented shoulder arthroplasty was reportedly performed by Jules Emile Pean in 1893 for tuberculosis [27].…”

Functional outcome in displaced proximal humeral fractures in adults treated by proximal humeral locking plates

“…Either deltopectoral or deltoid splitting approach were used. 13,14 All patients are immobilized in arm pouch with cuff and collar sling. Appropriate antibiotics and analgesics were used.…”

To asses the functional outcome of 2-part and 3-part proximal humerus fracture treated by proximal humerus nail and percutaneous fixation

“…The shoulder joint and its associated joints form one of the most complex joint systems of the human locomotor system. Its large range of motion is made possible by the interplay of 5 joints: sternoclavicular-joint, acromioclavicular-joint, glenohumeral joint, thoracoscapular joint and subacromial joint [1] . The proximal humerus consists of the head, anatomical neck and the greater and lesser tuberosities.…”