- See: Anterior Approach to Shoulder and Synthes Proximal Humerus Products
- Operative Treatment Options:
- Lateral Plating (Locking Plating):
- Percutaneous Pinning
- Screw Tension Band Technique:
- in some cases cancellous bone from the humerus head is removed to allow better impaction;
- insert 4.5 or 6.5 mm cancellous lag screw from the shaft up into the head, just shy of the subchondral bone;
- following screw insertion, figure of 8 tension band wiring (consider No 5 Ethibond) is passed
around the rotator cuff origin on greater tuberosity to a drill hole made in the humeral shaft;
- a second wire is inserted thru both the lesser and greater tuberosities;
- Internal fixation of proximal humerus fractures using the screw-tension band technique.
- Shoulder Replacement:
- need for revision is significantly higher in patients who underwent hemiarthoplasty for trauma
rather than for rheumatoid arthritis;
- upto one half of younger patients undergoing hemiarthroplasty will have subjective
or objective unsatisfactory results;
- technical considerations with fracture:
- IM nailing:
- main disadvantage of IM nailing is that shoulder adduction is required for nail entry into the medullary canal where as
shoulder abduction is often necessary for fracture reduction;
- Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures?
- avascular necrosis:
- Avascular necrosis of the humeral head treated by core decompression. A retrospective review.
- Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study.
- need to categorize the malunion w/ functional and anatomic characteristics;
- look for malposition of the tuberosities, incongruity of the articular surface, malalignment of the articular segment, soft
tissue contractures, rotator cuff tears, instability ect;
- w/ internal rotation contracture, Z lengthening of the subscapularis may be required;
- w/ operative correction of malunion, a good postoperative result requires correction of both soft tissue and osseous
- Operative treatment of malunion of a fracture of the proximal aspect of the humerus.
- Humeral tuberosity fractures. Evaluation by CT scan and management of malunion. Morris ME et al. Orthop Trans.
- pulmonary embolism:
- Pulmonary embolism after operative treatment of proximal humeral fractures
- screw cut out:
- Fracture Displacement and Screw Cutout After Open Reduction and Locked Plate Fixation of Proximal Humeral Fractures
The difficult proximal humerus fracture: tips and techniques to avoid complications and improve results.
Clinical use of the olecranon-manubrium percussion sign in shoulder trauma.
A posterior surgical approach to the proximal part of the humerus.
Displaced proximal humeral fractures. Seven years' experience with a modified Zickel supracondylar device.
Internal fixation techniques for proximal humeral fractures.
Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls.
Proximal humeral fractures. Management techniques and expected results.
The two-part proximal humeral fracture: a review of operative treatment using two techniques.
Proximal humeral fractures revisited.
Treatment of displaced proximal humeral fractures in elderly patients.