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Proximal humeral fractures
This document discusses the classification, decision making, surgical techniques, and complications for proximal humeral fractures. It covers Neer's classification, the AO classification, surgical approaches like the lateral deltoid splitting and anterolateral Mackenzie approaches. It also discusses indications for surgery like preventing nonunion, dislocations, or preserving rotator cuff function. Complications mentioned include adhesive capsulitis, avascular necrosis, nonunion, and hardware failure.
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Proximal humeral fractures
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- 3. What we alreadyknow…
- 4. Patient Profile • Twocategories – Osteoporotic – High energy injuries This affects decision making and surgical technique
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- 7. Neer >5 mm or45-degree displacement ? is it versatile enough
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- 12. Descriptive (Resch) • Valgustype • Varus type • Hinge intact / disrupted
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- 18. Decision Making • MajorityNon-operative (Appx 85%) – Sling for comfort, early motion
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- 36. Locking plate; Tips •Positioning
- 37. Locking plates: Tips •Rotator cuff control Images courtesy: AO
- 38. Locking plate: Tips •Belts and braces
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- 68. Hemiarthroplasty • Depth ofprosthesis • Version of prosthesis • Size of the head
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- 75. Prox humeral nail:top tip Image Courtesy: AO
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- 123. Let’s put itall together
- 124. Indications to operate •Prevent Non union – Shaft pulled medially
- 125. Indications to operate •# dislocations – If associated with neck fractures
- 126. Indications to operate •Preserve Cuff function – GT/LT displacement • Prevent malunion – Prevent impingement (height of head)
- 127. Indications to operate •Poor outcome # – Head splits – # dislocations ( 4 part) – Associated axillary nerve injury ?
- 128. Approaches • Lateral Deltoidsplitting Images courtesy:AO
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- 131. Other techniques I haveno experience with…
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- 135. Complications • Adhesive capsulitis •Avascular necrosis (AVN) • Nonunion • Metalwork cut Through
- 136. Summary • Common injury. •Refer to physio early if non displaced. • Lower threshold for surgery for younger cohort • Keep threshold for replacement high
- 137. Thoughts The severity ofinjury, perhaps, has the most significant bearing on the outcome. In Young patients – Restore anatomy and give biology a chance If Arthroplasty needed- reverse offers predictable results …”probably” superior to semi