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Proximal Humerus Fractures
Posted: May 8 2018 #(C101075)
A

Proximal Humerus Fracture in 65F

HPI

s/p fall from ladder while painting at home. No previous shoulder pain or complaints. Works part-time in a special-needs school.

PMH

No related history; nonsmoker and nondrinker

PE

Closed injury; gross neurovascular exam without deficit.

Poll
1 of 9
1. In addition to an AP radiograph, what additional imaging studies would you obtain to dictate treatment?
Complete Trauma Series (Scapular Y and Axillary)
11%
185/1601
Complete Trauma Series (Scapular Y and Axillary) AND a Velpeau
3%
58/1601
Complete Trauma Series (Scapular Y and Axillary) AND a CT Scan
38%
623/1601
Just a CT Scan (no additional xrays)
43%
691/1601
CT and MRI (no additional xrays)
2%
44/1601
2. Would you rely on a classification system to dictate treatment?
No
33%
505/1516
Yes - Neer Classification
50%
772/1516
Yes - AO/OTA
15%
239/1516
3. How would you treat this fracture?
Nonoperative
7%
112/1522
Operative
92%
1410/1522
4. If peforming operative fixation, what procedure would you perform?
Close Reduction Percutaneous Pinning (CRPP)
3%
59/1533
ORIF (e.g. Plate)
63%
974/1533
Intramedullary fixation
4%
64/1533
Total Shoulder Arthroplasty
3%
61/1533
Hemiarthroplasty
11%
182/1533
Reverse Shoulder Arthroplasty
11%
176/1533
Question does not apply to me
1%
17/1533
5. If performing ORIF, what internal fixation would you use?
Heavy nonabsorbable sutures
0%
4/1441
Isolated screws alone
0%
6/1441
Plate and Screws - Locking
93%
1341/1441
Plate and Screws - Non-Locking
3%
52/1441
Question does not apply to me
2%
38/1441
6. If performing ORIF, what approach would you use?
Deltopectoral
76%
1088/1414
Deltoid-splitting
21%
299/1414
Question does not apply to me
1%
27/1414
7. If performing ORIF, do you incorporate allograft struts in these cases?
Yes
27%
369/1357
No
68%
933/1357
Question does not apply to me
4%
55/1357
8. If you performed ORIF with a plate, when would you begin PASSIVE ROM?
Immediately
35%
496/1402
1 week
16%
230/1402
2 week
28%
402/1402
3 week
11%
156/1402
4 week or more
8%
118/1402
9. If you performed ORIF with a plate, when would you advance from passive to ACTIVE ROM?
Immediately
5%
77/1404
1 week
4%
58/1404
2 week
13%
183/1404
3 week
14%
205/1404
4 week
28%
407/1404
5 week
1%
22/1404
6 week or more
31%
442/1404
Question does not apply to me
0%
10/1404
PROCEDURE #1

ORIF proximal humerus fracture

Intra-procedure P1
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OUTCOMES
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