- See:
Anterior Approach to Shoulder and
Synthes Proximal Humerus Products
- Operative Treatment Options:
-
Percutaneous Pinning
-
Lateral Plating:
- Screw Tension Band Technique:
- reduction:
- 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 the
greater tuberosity to a drill hole made in the humeral shaft;
- a second wire is inserted thru both the lesser and greater tuberosities;
- references:
Internal Fixation of Proximal Humeral Fractures using the Screw Tension Band Technique. Cornell CN, Levine D, Pagnani MJ. J. Orthop. Trauma. 1994, 8:23-27;
-
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;
- references:
-
Acute prosthetic replacement for severe fractures of the proximal humerus.
- Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long Term Results. JW Sperling et al. JBJS Vol 80-A. No 4. Apr 1988.
-
Primary Hemiarthroplasty for Treatment of Proximal Humeral Fractures.
- 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;
- Complications:
-
non-union:
-
malunion:
- 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 abnormalities;
- references:
- Operative treatment of malunion of a fracture of the proximal aspect of the humerus. PK Beredjiklian MD et al. JBJS. Vol 80-A. No 10. Oct 1998. p 1484.
- Humeral tuberosity fractures. Evaluation by CT scan and management of malunion. ME Morris et al. Orthop. Trans. Vol 11. 1987. p 242.
- pulmonary embolism:
-
Pulmonary embolism after operative treatment of proximal humeral fractures
- screw cut out:
-
Displacement/Screw Cutout After Open Reduction and Locked Plate Fixation of 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.
The three-part fracture of the proximal part of the humerus. Operative x treatment. x
Avascular necrosis of the humeral head treated by core decompression. A retrospective review.
Internal fixation techniques for proximal humeral fractures. x
Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study.
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.
Open reduction and fixation of proximal humeral fractures and fracture-dislocations.
Proximal humeral fractures revisited.
A Biomechanical Analysis of Prophylactic Fixation for Pathological Fractures of the Distal Third of the Humerus.
Treatment of two- and three-part fractures of the proximal humerus. Bigliani LU. Instructional Course Lectures. 38:231-44, 1989.
Complex upper-extremity fractures. Zych GA. Instructional Course Lectures. 39:259-64, 1990.
Treatment of displaced proximal humeral fractures in elderly patients.
The sub-deltoid approach to the metaphyseal region of the humerus.
