- Reduction of the Displaced Fracture:
- if anterior angulation is > 45 deg, forward elevation will be limited;
- gentle traction w/ flexion and some adduction is usually all that is needed to position arm in
pivotal portion so that it can be impacted under head;
- gental traction is placed on arm as it is brough out to side & then gently flexed;
- traction should be maintained, and flexion is increased as the arm is gradually adducted to gain
reduction of shaft beneath the head;
- adduction neutralizes pull of pectoralis major & other internal rotators, which are creating the deformity;
- impact proximal shaft beneath humeral head;
- if reduction is not possible, there may be interposition of soft tissue, either muscle, capsule, or long head of
biceps;
- often long head of biceps is caught in frx site, creating tether that will distract frx w/ repeated attempts at reduction;
- this situation requires ORIF:
