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Sling and swathe for 6 weeks then physical therapy
3%
46/1463
Reverse total shoulder arthroplasty
1%
14/1463
ORIF of proximal humerus
88%
1281/1463
Closed reduction and percutaneous pinning of the greater tuberosity
4%
65/1463
Hemiarthroplasty
45/1463
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The radiograph shows a valgus impacted 4-part proximal humerus fracture. Due to the patient's young age, active lifestyle, and the displacement of the greater tuberosity operative management is necessary. Open reduction internal fixation has been shown in multiple studies to provide the best long term outcome in this patient population. ORIF allows for restoration of anatomical alignment, reducing the possibility of impingement and weakness from the greater tuberostiy malunion. The Robinson article reviewed series of 25 severely impacted proximal humerus fractures that all underwent ORIF and went on to union. Wijgman et al reviewed the results of 60 patients with 3 or 4 part fractures who underwent ORIF with a T-plate or cerclage wires and found 87% had good/excellent results based on the Constant score. Interestingly 22 pts (37%) had AVN, yet 17 of these 22 (77%) patients had excellent/good Constant scores.
4.2
(24)
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