Internal fixation techniques for proximal humeral fractures. x

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Hawkins RJ. Kiefer GN. x Clinical Orthopaedics & Related Research. [JC:dfy] (223):77-85, 1987 Oct. x Operative treatment of proximal humeral fractures is performed with a x variety of fixation techniques. Selection of the optimum device for x fixation is dependent on anatomic considerations, fracture x characteristics, surgical exposure, and biomechanical features of fixation x devices. Fixation objectives are evaluated in light of Neer's four segment x classification. An extended deltopectoral approach with release of x anterior deltoid distal insertion as well as the proximal pectoralis major x raphe provides a wide exposure. The approach heals rapidly and allows x rapid rehabilitation. The shoulder fracture fragments are adaptable to x tension band wiring. With loss of bone stock, tension band wiring becomes x increasingly important because compression or shearing forces can be x expended in the tendinous insertion of the fragments. Fixation principles x are applied according to specific fracture patterns. Whatever the choice x of fixation method, a protracted and vigorous rehabilitation program is x essential to achieve maximal functional recovery. x