Posted: Jan 30 2021 #(C101708) 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope

Proximal Humerus Fracture in 61M

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HPI

A 61-year-old male presents with right shoulder pain after a fall off a ladder. He admits to pain with any movement of the shoulder. Denies any numbness and tingling of the extremity.

PMH

He lives alone and works full-time. The patient works in construction. +Smoker

Physical examination reveals tenderness over the right proximal humerus with mild swelling and ecchymosis. A focused neurological exam reveals ability to fire finger flexors and extensors, wrist flexors and extensors. Sensation intact to light touch throughout. Vascular exam is normal.

Poll

1 of 8

1. In addition to the radiographs provided, would you obtain any further imaging to guide your initial treatment?

No - Current radiographs are sufficient

49%

756/1526

Yes - additional x-rays (XR)

60/1526

Yes - CT scan

40%

611/1526

Yes - MRI

18/1526

Yes - XR + CT

36/1526

Yes - XR + MRI

3/1526

Yes - CT + MRI

16/1526

Yes - XR + CT + MRI

0/1526

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

26/1526

2. Would you use a classification system to guide management?

No - a classification system would not help me

39%

579/1454

Yes - AO/OTA

12%

186/1454

Yes - Neer classification

36%

533/1454

Yes - descriptive

93/1454

Other

4/1454

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

59/1454

3. How would you have initially managed this patient?

Nonoperative

25%

376/1479

Operative

72%

1079/1479

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

24/1479

4. If you choose Operative management for the initial injury, what surgery would you perform?

I would not choose Operative management

81/1474

External fixation (ExFix)

5/1474

Open reduction and internal fixation (ORIF)

64%

953/1474

Intramedullary nail (IMN)

25%

375/1474

Shoulder arthroplasty

23/1474

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

37/1474

5. If you choose intramedullary nail (IMN) for the initial injury, what would you?

I would not choose IMN

46%

644/1396

Short humeral nail

33%

461/1396

Long humeral nail

17%

239/1396

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

52/1396

6. How would you manage the patient's periprosthetic fracture?

Nonoperative

11%

130/1181

Operative

75%

896/1181

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

13%

155/1181

7. If you choose Operative management for the periprosthetic injury, what surgery would you perform?

I would not choose Operative management

29/1083

External fixation (ExFix) only

8/1083

Retain IMN + ORIF

19%

216/1083

Remove IMN + ORIF

21%

236/1083

Revision IMN only

28%

312/1083

Revision IMN + ORIF

10%

112/1083

Shoulder arthroplasty

67/1083

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

103/1083

8. If you choose Operative management for the periprosthetic injury and obtain the construct shown, what weight-bearing status would you assign the patient postoperatively?

I would not choose the construct below

34/915