Radiological External Picture of Proximal Humerus Fracture After Surgery at Haji Adam Malik Hospital
Keywords:
Proximal Humerus Fracture, ORIF, Radiological Evaluation, Neck-Shaft Angle, Humeral Head Height
Abstract
Proximal humerus fractures are among the most common musculoskeletal injuries, particularly in elderly patients with decreased bone density. Open Reduction and Internal Fixation (ORIF) is a widely used surgical technique aimed at restoring anatomical alignment and achieving stable fixation. This study aimed to evaluate postoperative radiological outcomes of proximal humerus fractures treated with ORIF at H. Adam Malik Hospital, Medan.
This research employed a descriptive observational design with a cross-sectional approach using retrospective data from medical records of patients treated between January 2021 and December 2024. A total of 25 patients who met the inclusion criteria were analyzed. Radiological parameters assessed included neck-shaft angle (NSA), humeral head height (HHH), medial offset (MO), medial hinge gap (MHG), and acromiohumeral interval (AHI). Measurements were conducted by two independent observers, and inter-observer reliability was evaluated using the Intraclass Correlation Coefficient (ICC).
The results showed that the majority of patients were female (68%), with the largest age group being 18–49 years (44%). The inter-observer reliability demonstrated excellent agreement (ICC = 0.947). The mean values of radiological parameters were: NSA 127.83° ± 7.28°, HHH 8.87 ± 1.72 mm, MO 8.74 ± 2.97 mm, MHG 2.28 ± 0.73 mm, and AHI 7.60 ± 1.37 mm. These findings indicate that most parameters were within normal limits, although NSA tended toward mild varus alignment and MHG exceeded the ideal anatomical threshold.
In conclusion, postoperative radiological outcomes of proximal humerus fractures treated with ORIF generally showed acceptable alignment and fixation stability. However, attention to medial support restoration is necessary to prevent complications such as varus collapse. Radiological evaluation remains essential for assessing surgical success and predicting functional outcomes.
References
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10. Khmelnitskaya E, Lamont LE, Taylor SA, Lorich DG, Dines DM, Dines JS. Evaluation and management of proximal humerus fractures. Adv Orthop. 2012;2012:861598.
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12. Reeve J. Role of cortical bone in hip fracture. Bonekey Rep. 2017;6:867.
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15. Pallavi KT, Saini M. Anatomy of the Joints and Movement.
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17. Rudran B, Little C, Duff A, Poon H, Tang Q. Proximal humerus fractures: anatomy, diagnosis and management. Br J Hosp Med. 2022 July 2; 83(7):1–10.
18. Walter N, Szymski D, Kurtz SM, Lowenberg DW, Alt V, Lau E, et al. Proximal humerus fractures – epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data. Bone & Joint Research. 2023 Feb 1; 12(2):103–12.
19. Solomon L, Warwick D, Nayagam S, Apley AG. Apley's system of orthopaedics and fractures. 9th ed. London: Hodder Arnold; 2010. 974 p.
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21. Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat Res. 2013 Jan; 471(1):39–43.
22. Humerus. Journal of Orthopaedic Trauma. 2018 Jan; 32(1):S11–20.
23. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. 2018 Jan; 32(1):S1–10.
24. Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults—A Scoping Review. JCM. 2022 Oct 18; 11(20):6140.
25. Davis BP, Mauter LA, Sears BW, Hatzidakis AM. Intramedullary Nailing Technique for Proximal Humeral Fractures Using a Straight Antegrade Nail with Locking Tuberosity Fixation. JBJS Essent Surg Tech. 2024; 14(3):e23.00040.
26. Bahrs C, Rolauffs B, Südkamp NP, Schmal H, Eingartner C, Dietz K, et al. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography. BMC Musculoskeletal Disord. 2009 Apr 2;10:33.
27. Rudran B, Little C, Duff A, Poon H, Tang Q. Proximal humerus fractures: anatomy, diagnosis and management. Br J Hosp Med (Lond). 2022 July 2; 83(7):1–10.
28. Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and Imaging of Proximal Humerus Fractures. Orthopedic Clinics of North America. Oct. 2008; 39(4):393–403.
29. Assunção JH, Malavolta EA, Beraldo RA, Gracitelli MEC, Bordalo-Rodrigues M, Ferreira Neto AA. Impact of shoulder rotation on neck-shaft angle: A clinical study. Orthopaedics & Traumatology: Surgery & Research. 2017 Oct; 103(6):865–8.
30. Canbora M, Kose O, Polat A, Konukoglu L, Gorgec M. Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study. Int J Shoulder Surg. 2013; 7(3):105.
31. Longo UG, Gulotta LV, De Salvatore S, Berton A, Piergentili I, Bandini B, et al. The Role of Humeral Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty: 155° versus <155°—A Systematic Review. J Clin Med. 2022 June 23; 11(13):3641.
32. Suroto H, Licindo D, Wibowo PA, Gultom GRR, Aprilya D, Setiawati R, et al. Morphology of Humeral Head and Glenoid in Normal Shoulder of Indonesian Population. ORR. 2022 Dec; Volume 14:459–69.
33. Cui X, Chen H, Ma B, Fan W, Li H. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskeletal Disord. 2019 Nov 3; 20(1):511.
34. Hufeland M, Brusis C, Kubo H, Grassmann J, Latz D, Patzer T. The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff. Knee surg sports traumatol arthrosc. 2021 July; 29(7):2085–9.
35. Ongbumrungphan W, Srikhum W, Chernchujit B. The Effect of Radiographic Beam Angle on Acromiohumeral Interval: 3D-CT Analytic Study. J Med Assoc Thai. 2015 Apr; 98 Suppl 3:S61-65.
36. Sakdapanichkul C, Chantarapitak N, Kasemwong N, Suwanalai J, Wimolsate T, Jirawasinroj T, et al. Transcending Patient Morphometry: Acromiohumeral Interval to Glenoid Ratio as a Universal Diagnostic Tool for Massive Rotator Cuff Tears. Clin Orthop Surg. 2024; 16(4):578.
37. Gardentroek TJ, Oud S, Formijne Jonkers HA, Goslings JC. Supporting the medial hinge in proximal humerus fractures with an intramedullary plate. Trauma Case Rep. 2021 June;33:100474.
38. Yoon JR, Koh YY, Lee SH. Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy. J Orthop Surg Res. 2023 Mar 20; 18(1):219.
39. Irlenbusch U, Berth A, Blatter G, Zenz P. Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty. Int Orthop. 2012 Mar; 36(3):587–93.
40. Camus D, Galland A, Airaudi S, Mancini J, Gravier R. Total shoulder prosthesis with humeral resurfacing: Impact on lateral offset and short-term clinical consequences. Orthopaedics & Traumatology: Surgery & Research. 2018 Oct; 104(6):787–91.
41. Dheenadhayalan J, Prasad VD, Devendra A, Rajasekaran S. Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: A study of 127 cases. J Orthop Surg (Hong Kong). 2019 May 1; 27(2):2309499019848166.
42. Sanjay Imaw, Suyasa IK, because MB. Correlation of Central Column Diaphyseal Angle, Humeral Head Height, Greater Tuberosity to Articular Surface Distance, Age and Fracture Pattern with Constant Murley Score Functional Outcomes in Post-ORIF PHILOS Patients with Proximal Humerus Fracture. Int J Res Rev. 2024 Dec 26; 11(12):512–21.
43. Barth J, Garret J, Boutsiadis A, Sautier E, Geais L, Bothorel H, et al. Is global humeral head offset related to intramedullary canal width? A computer tomography morphometric study. Journal of Experimental Orthopaedics. 2018 Jan 1; 5(1):35. Available from:https://doi.org/10.1186/s40634-018-0148-2
2. Abdelsalam AE, Ahmed MHA, Bakr HMA, Abdelkader SM. Evaluation of Proximal Humerus Internal Locking System in Management of Proximal Humeral Fractures. The Egyptian Journal of Hospital Medicine. 2022 Apr 1; 87(1):1713–9.
3. Hansen JT, Netter FH. Netter's clinical anatomy. 4th edition. Philadelphia, PA: Elsevier; 2019. 517–548 p. (Netter basic science).
4. Miller MD, Thompson SR. Miller's Review of Orthopaedics, 8th Edition. 1st ed. United Kingdom: Elsevier; 2023. (1; vol. 8).
5. Khmelnitskaya E, Lamont LE, Taylor SA, Lorich DG, Dines DM, Dines JS. Evaluation and Management of Proximal Humerus Fractures. Advances in Orthopedics. 2012; 2012:1–10.
6. Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg. 2008; 17(1):42–54.
7. Jia XY, Chen YX, Qiang MF, Zhang K, Li HB, Jiang YC, et al. Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography. Orthop Surg. 2017 May; 9(2):167–73.
8. Kan SA, Chang WC, Cheng MF, Hsu KH, Su YP. Inferior subluxation of the humeral head after plate surgery for proximal humerus fracture is not always benign. Journal of Shoulder and Elbow Surgery. 2025 Oct; 34(10):2322–9.
9. Kanchanatawan W, Suppauksorn S, Densiri-Aksorn W, Kittithamvongs P, Pongpinyopap W. Fluoroscopic Technique for Open Reduction and Internal Fixation of Proximal Humeral Fracture Using the Proximal Humeral Locking Plate: Proposal of “Plate” and “Screw” Views. Arthrosc Tech. Aug. 2017; 6(4):e1009–14.
10. Khmelnitskaya E, Lamont LE, Taylor SA, Lorich DG, Dines DM, Dines JS. Evaluation and management of proximal humerus fractures. Adv Orthop. 2012;2012:861598.
11. Mostafa E, Imonugo O, Varacallo MA. Anatomy, Shoulder and Upper Limb, Humerus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Apr 7]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534821/
12. Reeve J. Role of cortical bone in hip fracture. Bonekey Rep. 2017;6:867.
13. Elzanie A, Varacallo MA. Anatomy, Shoulder and Upper Limb, Deltoid Muscle. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537056/
14. Gilbert GM, Nelson R. Anatomy, Shoulder and Upper Limb, Anterior Humeral Circumflex Artery. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557892/
15. Pallavi KT, Saini M. Anatomy of the Joints and Movement.
16. Syros A, Rizzo MG. Anatomy, Shoulder and Upper Limb, Teres Major Muscle. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Nov 2]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK580487/
17. Rudran B, Little C, Duff A, Poon H, Tang Q. Proximal humerus fractures: anatomy, diagnosis and management. Br J Hosp Med. 2022 July 2; 83(7):1–10.
18. Walter N, Szymski D, Kurtz SM, Lowenberg DW, Alt V, Lau E, et al. Proximal humerus fractures – epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data. Bone & Joint Research. 2023 Feb 1; 12(2):103–12.
19. Solomon L, Warwick D, Nayagam S, Apley AG. Apley's system of orthopaedics and fractures. 9th ed. London: Hodder Arnold; 2010. 974 p.
20. Attum B, Thompson JH. Humerus Fractures Overview. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Oct 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482281/
21. Carofino BC, Leopold SS. Classifications in brief: the Neer classification for proximal humerus fractures. Clin Orthop Relat Res. 2013 Jan; 471(1):39–43.
22. Humerus. Journal of Orthopaedic Trauma. 2018 Jan; 32(1):S11–20.
23. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. 2018 Jan; 32(1):S1–10.
24. Baker HP, Gutbrod J, Strelzow JA, Maassen NH, Shi L. Management of Proximal Humerus Fractures in Adults—A Scoping Review. JCM. 2022 Oct 18; 11(20):6140.
25. Davis BP, Mauter LA, Sears BW, Hatzidakis AM. Intramedullary Nailing Technique for Proximal Humeral Fractures Using a Straight Antegrade Nail with Locking Tuberosity Fixation. JBJS Essent Surg Tech. 2024; 14(3):e23.00040.
26. Bahrs C, Rolauffs B, Südkamp NP, Schmal H, Eingartner C, Dietz K, et al. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures: a comparative study of plain radiography and computed tomography. BMC Musculoskeletal Disord. 2009 Apr 2;10:33.
27. Rudran B, Little C, Duff A, Poon H, Tang Q. Proximal humerus fractures: anatomy, diagnosis and management. Br J Hosp Med (Lond). 2022 July 2; 83(7):1–10.
28. Robinson BC, Athwal GS, Sanchez-Sotelo J, Rispoli DM. Classification and Imaging of Proximal Humerus Fractures. Orthopedic Clinics of North America. Oct. 2008; 39(4):393–403.
29. Assunção JH, Malavolta EA, Beraldo RA, Gracitelli MEC, Bordalo-Rodrigues M, Ferreira Neto AA. Impact of shoulder rotation on neck-shaft angle: A clinical study. Orthopaedics & Traumatology: Surgery & Research. 2017 Oct; 103(6):865–8.
30. Canbora M, Kose O, Polat A, Konukoglu L, Gorgec M. Relationship between the functional outcomes and radiological results of conservatively treated displaced proximal humerus fractures in the elderly: A prospective study. Int J Shoulder Surg. 2013; 7(3):105.
31. Longo UG, Gulotta LV, De Salvatore S, Berton A, Piergentili I, Bandini B, et al. The Role of Humeral Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty: 155° versus <155°—A Systematic Review. J Clin Med. 2022 June 23; 11(13):3641.
32. Suroto H, Licindo D, Wibowo PA, Gultom GRR, Aprilya D, Setiawati R, et al. Morphology of Humeral Head and Glenoid in Normal Shoulder of Indonesian Population. ORR. 2022 Dec; Volume 14:459–69.
33. Cui X, Chen H, Ma B, Fan W, Li H. Fibular strut allograft influences reduction and outcomes after locking plate fixation of comminuted proximal humeral fractures in elderly patients: a retrospective study. BMC Musculoskeletal Disord. 2019 Nov 3; 20(1):511.
34. Hufeland M, Brusis C, Kubo H, Grassmann J, Latz D, Patzer T. The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff. Knee surg sports traumatol arthrosc. 2021 July; 29(7):2085–9.
35. Ongbumrungphan W, Srikhum W, Chernchujit B. The Effect of Radiographic Beam Angle on Acromiohumeral Interval: 3D-CT Analytic Study. J Med Assoc Thai. 2015 Apr; 98 Suppl 3:S61-65.
36. Sakdapanichkul C, Chantarapitak N, Kasemwong N, Suwanalai J, Wimolsate T, Jirawasinroj T, et al. Transcending Patient Morphometry: Acromiohumeral Interval to Glenoid Ratio as a Universal Diagnostic Tool for Massive Rotator Cuff Tears. Clin Orthop Surg. 2024; 16(4):578.
37. Gardentroek TJ, Oud S, Formijne Jonkers HA, Goslings JC. Supporting the medial hinge in proximal humerus fractures with an intramedullary plate. Trauma Case Rep. 2021 June;33:100474.
38. Yoon JR, Koh YY, Lee SH. Estimation of the proper gap ratio using preoperative radiography for posterior tibial slope maintenance in biplanar open wedge high tibial osteotomy. J Orthop Surg Res. 2023 Mar 20; 18(1):219.
39. Irlenbusch U, Berth A, Blatter G, Zenz P. Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty. Int Orthop. 2012 Mar; 36(3):587–93.
40. Camus D, Galland A, Airaudi S, Mancini J, Gravier R. Total shoulder prosthesis with humeral resurfacing: Impact on lateral offset and short-term clinical consequences. Orthopaedics & Traumatology: Surgery & Research. 2018 Oct; 104(6):787–91.
41. Dheenadhayalan J, Prasad VD, Devendra A, Rajasekaran S. Correlation of radiological parameters to functional outcome in complex proximal humerus fracture fixation: A study of 127 cases. J Orthop Surg (Hong Kong). 2019 May 1; 27(2):2309499019848166.
42. Sanjay Imaw, Suyasa IK, because MB. Correlation of Central Column Diaphyseal Angle, Humeral Head Height, Greater Tuberosity to Articular Surface Distance, Age and Fracture Pattern with Constant Murley Score Functional Outcomes in Post-ORIF PHILOS Patients with Proximal Humerus Fracture. Int J Res Rev. 2024 Dec 26; 11(12):512–21.
43. Barth J, Garret J, Boutsiadis A, Sautier E, Geais L, Bothorel H, et al. Is global humeral head offset related to intramedullary canal width? A computer tomography morphometric study. Journal of Experimental Orthopaedics. 2018 Jan 1; 5(1):35. Available from:https://doi.org/10.1186/s40634-018-0148-2
Published
2026-04-30
How to Cite
Teuku Reza Syahputera Sofyan, Nino Nasution, & Pranajaya Dharma Kadar. (2026). Radiological External Picture of Proximal Humerus Fracture After Surgery at Haji Adam Malik Hospital. International Journal of Health, Economics, and Social Sciences (IJHESS), 8(2), 1756~1761. https://doi.org/10.56338/ijhess.v8i2.10985
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Copyright (c) 2026 Teuku Reza Syahputera Sofyan, Nino Nasution, Pranajaya Dharma Kadar
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