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Closed reduction and percutaneous pinning
1%
8/937
Shoulder hemiarthroplasty
27%
257/937
Superior capsular reconstruction (SCR)
13/937
Open reduction and internal fixation (ORIF) with or without bone grafting
67%
627/937
Reverse total shoulder replacement with lattismus dorsi transfer to assist with internal rotation
2%
18/937
Select Answer to see Preferred Response
Treatment of 2 part proximal humerus malunion in patient with good bone stock with evidence of arthritis or osteonecrosis can be effectively treated with ORIF with locked plating with or without bone grafting. Treatment of a chronic nonunion of the proximal humerus in the elderly should be treated with fixation when possible. Critical attention should be paid to correct all deformities: tuberosity positioning, articular surface realignment, soft tissue balancing, rotator cuff repair (when needed), and treatment of soft tissue contractures. Attempts at arthroplasty are generally recommended only when the fracture has eroded enough to prevent successful fixation, if the tuberosities have resorbed, if the rotator cuff has a pre-existing tear, or other findings are present that would limit the success rate of fixation. Quadlbauer et al. evaluated the results of ORIF with locked plating without bone grafting for 9 patients with proximal humerus non-unions with a mean 31-month followup. They noted that all 9 patients went on achieve bony union with improvement in ROM in all planes except fo adduction. They concluded that ORIF with locked plating without bone grafting is a reasonable and safe option for treating proximal humerus nonunion with high union rates and minimal risk of complications Cadet et al. in a JAAOS review article discussed the various management options for proximal humerus non-unions. The authors noted that several recent series did demonstrate union in >90% of patients treated with reconstruction using locking plates and autogenous bone graft. They discuss that while reverse shoulder arthroplasty (rTSA) has also showed excellent clinical results, its should be reserve for patients with nonviable humeral heads, severe humeral osteoporosis Incorrect Answers: Answer 1: There is no role for closed reduction in the setting of a non-union Answer 2: While rTSA has shown great results with, similar results have not recently been shown for shoulder hemiarthroplasty Answer 3: SCR is reserved for a patient with irreparable superior rotator cuffs who are considered too young to undergo arthroplasty Answer 5: While rTSA is an effective treatment option here, the addition of a lattismus dorsi transfer would assist with EXTERNAL rotation not INTERNAL rotation.
2.8
(37)
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