Posted: Nov 9 2024 #(C102601)

RSA Periprosthetic Humerus Fracture in 75F

;

HPI

This is a 75-year-old female who is 9 months status post left reverse total shoulder arthroplasty. She has had a series of falls and presents with left shoulder pain.

PMH

The patient has a history of osteoporosis and pancreatic cancer, currently in remission following a Whipple procedure. The patient has a BMI of 19, indicative of a low body mass index.

On physical exam, she has pain and a limited range of motion. She is neurovascular intact distally.

Poll

1 of 1

1. If you choose Open reduction & internal fixation (ORIF) Alone with Plate(s), how many plates would you use, and what type?

I would not choose ORIF Alone with Plates

10%

30/274

Single Plate - Proximal Humerus Locking Plate

14%

40/274

https://upload.orthobullets.com/topic/423193/images/0ae4275b-3d30-4cea-8ecd-f7a3e6dd7ab2_pangea_proximal_humerus_1.jpg

https://upload.orthobullets.com/topic/423193/images/17952552-b960-49d4-b723-719304e19f63_pangea_proximal_humerus_2..jpg

https://upload.orthobullets.com/topic/423193/images/5b7725f5-e7b4-487b-b56b-3a2241449d93_24ed3534-bf5f-42e5-b6f1-46cc7ea28b37_3_mos_po.jpg

https://upload.orthobullets.com/topic/423193/images/33e25aad-3634-423a-9302-c79002362d61_f847a2b6-f6f1-4c6a-993b-7fc79d21ca67_3_mos_post.jpg

https://upload.orthobullets.com/topic/423194/images/33ce961f-c9b0-446e-8d19-211ead2b1bab_pangea_proximal_humerus_posterior_1.jpg

https://upload.orthobullets.com/topic/423194/images/281a8955-ff7b-475b-bccd-bd417925a05a_pangea_proximal_humerus_posterior_2.jpg

Single Plate - Large Fragment Plate

35%

96/274

Single Plate - Small Fragment Plate

10/274

Single Plate - Recon Plate

22/274

Dual Plate - Proximal Humerus Locking Plate + Small Fragment Plate

10%

28/274

Dual Plate - Large Fragment Plate + Small Fragment Plate

27/274

Dual Plate - Recon Plate + Small Fragment Plate

7/274

Dual Plate - Other combination

5/274

Outside of my area of expertise - best if I don't vote

9/274

Intra-procedure P1

14 days after

Post-procedure P1

3 months after

Post-procedure P1

In addition to AP and LAT radiographs of the humerus (includes the joint above and below), what additional imaging studies would you obtain to determine management?

CT Alone

If you choose operative management, what procedure(s) would you perform?

Open reduction and internal fixation (ORIF) Alone

If you choose Open reduction & internal fixation (ORIF) Alone, what fixation construct would you use?

Cerclage(s) + Plate(s)

If you choose Open reduction & internal fixation (ORIF) Alone with Plate(s), how many plates would you use, and what type?

Single Plate - Proximal Humerus Locking Plate

If you choose Open reduction & internal fixation (ORIF) Alone with a Single Plate, would you augment it with a strut graft, and if so, what type?

Yes - allograft Tibia

If you choose Open reduction & internal fixation (ORIF) Alone with Cerclage and Plate, what type of cerclage would you use?

Suture cerclage