Complex proximal humerus fractures: Hertel's criteria reliability to predict head necrosis.

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Abstract

[Indexed for MEDLINE] 4. Eur J Trauma Emerg Surg. 2026 Mar 17;52(1):102. doi: 10.1007/s00068-026-03148-x. Does the Hertel criteria correlate with postoperative avascular necrosis and failure in proximal humerus fractures? A retrospective cohort study. Ismailov S(1), Bacaksiz T(2), Maden M(3), Akan I(2), Onder Y(4), Kazimoglu C(2). Author information: (1)Department of Orthopaedics and Traumatology, Mardin Kızıktepe State Hospital, Mardin, Turkey. (2)Department of Orthopaedics and Traumatology, Izmir Katip Celebi University, Izmir, Turkey. (3)Department of Orthopaedics and Traumatology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey. mhmtmdn@gmail.com. (4)Department of Orthopaedics and Traumatology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey. PURPOSE: Avascular necrosis and failure are significant complications following surgical fixation of proximal humerus fractures. The Hertel criteria are a widely used morphological classification system intended to predict humeral head ischaemia. This study aimed to evaluate the correlation of Hertel criteria with the development of postoperative avascular necrosis and failure and to assess the prognostic value of other radiological parameters. MATERIALS AND METHODS: In this retrospective cohort study, 94 patients with proximal humerus fractures treated with locking plate fixation and a minimum 2-year follow-up were included. Preoperative radiographs and computed tomography scans were used to assess Hertel criteria, Neer classification, and proximal humeral cortical thickness. Postoperative radiographs were evaluated for avascular necrosis and failure, defined as a composite of nonunion, severe avascular necrosis, screw penetration, severe deformity, or significant arthrosis. Clinical outcomes were assessed using the Visual Analog Scale and Disability of Arm, Shoulder and Hand scores. RESULTS: The presence of an anatomical neck fracture and tubercle displacement greater than 10 mm were significantly associated with both avascular necrosis and failure (p