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Proximal Humerus Fractures
Posted: Feb 11 2020 #(C101381)
A

Proximal Humerus Fracture in 72M

HPI

s/p fall from standing

PMH

HTN, CAD

PE

No neurovascular deficits

Poll
1 of 11
1. In addition to the provided xrays what additional imaging studies would you obtain to guide treatment?
None - initial xrays are enough
18%
343/1858
Additional Xray Views
1%
32/1858
Ultrasound
0%
3/1858
CT scan
66%
1236/1858
MRI
4%
85/1858
CT and MRI
5%
106/1858
Additional Xrays, CT, and MRI
1%
19/1858
Outside my area of expertise - best if I don't vote
1%
34/1858
2. Would you use a classification system to help determine treatment?
No - a classification system does not help me
35%
617/1760
Yes - AO/OTA Classification
16%
294/1760
Yes- Neer
44%
786/1760
Outside my area of expertise - best if I don't vote
3%
63/1760
3. How would you treat this injury?
Nonoperative (sling)
5%
97/1790
Operative
93%
1669/1790
Outside my area of expertise - best if I don't vote
1%
24/1790
4. If you choose Operative Treatment, what would you do?
Closed Reduction Percutaneous Pinning (CRPP)
0%
16/1782
ORIF
5%
104/1782
Intramedullary Nail (proximal humerus nail)
1%
22/1782
Arthroplasty
89%
1586/1782
I would not choose operative treatment
1%
20/1782
Outside my area of expertise - best if I don't vote
1%
34/1782
5. If you choose Arthroplasty, what procedure would you perform?
Hemiarthroplasty
17%
311/1759
Total shoulder Arthroplasty (TSA)
8%
147/1759
Reverse Total Shoulder Arthroplasty (rTSA)
71%
1249/1759
I would not choose Arthroplasty
0%
13/1759
Outside my area of expertise - best if I don't vote
2%
39/1759
6. If you choose Arthroplasty, when would you ideally perform the surgery?
Within 6 hours
1%
27/1704
Within 24 hours
10%
171/1704
Within 48 hours
15%
256/1704
Within 72 hours
25%
433/1704
> 72 hours when my schedule allows
43%
744/1704
I would not choose Arthroplasty
0%
13/1704
Outside my area of expertise - best if I don't vote
3%
60/1704
7. If you choose reverse TSA, would you attempt to repair the tuberosities.
Absolutely - it is very important for clinical outcomes
37%
619/1650
I would try - it is somewhat important
38%
627/1650
No - it is not important
16%
275/1650
I would not choose Reverse TSA
3%
57/1650
Outside my area of expertise - best if I don't vote
4%
72/1650
8. If you choose Reverse Total Shoulder Arthroplasty for this Fx, would you choose a prosthesis design with a Medialized/Lateralized glenoid, Medialized/Lateralized Humerus?
Medialized Glenoid, Medialized Humerus (Grammont Style)
15%
114/755
Medialized Glenoid, Lateralized Humerus
29%
219/755
Lateralized Glenoid, Medialized Humerus
30%
230/755
I would not choose Reverse TSA
4%
35/755
Outside my area of expertise - best if I don't vote
20%
157/755
9. If you choose ORIF, what type of fixation would you choose to use?
Heavy Nonabsorbable Sutures Only (no hardware)
2%
31/1525
Isolated Screw Fixation +/- heavy sutures
1%
21/1525
Locking Plate +/- heavy sutures
24%
374/1525
I would not perform ORIF
69%
1063/1525
Outside my area of expertise - best if I don't vote
2%
36/1525
10. If you choose ORIF, what approach would you use?
Anterolateral approach
21%
327/1488
Deltoid splitting approach
9%
145/1488
I would not perform ORIF
66%
987/1488
Outside my area of expertise - best if I don't vote
1%
29/1488
11. If you choose ORIF with a locking plate, would you use an intramedullary fibular allograft?
Yes - fibular allograft
11%
167/1456
No
13%
197/1456
I would not perform ORIF with a locking plate
71%
1043/1456
Outside my area of expertise - best if I don't vote
3%
49/1456
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