- Two Part Articular Segment Displacement:
- fracture plane is thru the anatomic (not
surgical neck);
- anatomic neck represents the old eiphyseal plate;
-
surgical neck represents the weakened area below the tuberosities
and head approximately 2 cm distal to the anatomic neck;
- significant chondral defects and minimally separated fragments may go
unappreciated on plain films;
- through no soft tissue remains attached to the humeral head, the
undisturbed blood supply transmitted thru the tuberosities may
prevent osteonecrosis of the articular segment;
- Treament:
- ORIF vs. prosthetic
arthroplasty;
- in young active pts, consider screws from the shaft into head may be
inserted thru an anterior approach;
- it may prove difficult to obtain adequate screw purchase in the head
fragment without violating the articular surface;
- prosthetic hemiarthroplasty may be indicated in older pts;
- deltopectoral approach with release of the
subscapularis
tendon from lesser tuberosity affords excellent exposure;
- following removal of the head fragment and reaining of the
shaft, the humeral component is implanted in 30 to 40 deg
of retroversion relative the epicondyles of the elbow;
