Proximal Humerus Fractures

Topic

Trauma - UL

Podcast

039

Updated

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What is the main blood supply to the humeral head?

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What investigations are needed?

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Why does the X-ray sometimes show subluxation?

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How is it classified?

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What X-ray features predict avascular necrosis (AVN)?

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Does AVN always develop with these risk features?

Case Scenarios

1. Elderly, comminuted # = RTSA

"Elderly lady with high function, comminuted proximal humerus fracture and high risk features for AVN"

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How will you manage this patient? P and I

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Options for replacement?

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How does RTSA work?

2. Young, comminuted # = ORIF

"Young male with comminuted fracture. Despite features suggesting risk of AVN, given that 8/10 similar cases did not develop AVN, will proceed with fixation and reserve replacement as a salvage procedure"

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Options for fixation? When will you use a nail?

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How will you surgically fix this fracture?

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Evidence for Kickstand Screw?

3. Elderly for Non Op

"Elderly lady with poor function and non-dominant arm—candidate for non-operative management"

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What do you know about the PROPHER Trial?

4. Fracture-Dislocation

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How will you manage this fracture-dislocation in the ED?

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What will you do if this is a group 3 fracture?

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What will be the surgical plan?

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What is the mechanism of shoulder fracture-dislocation?

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A slack hand causes poverty, but the hand of the diligent makes rich. Proverbs 10:4