4.0 of 33 Ratings
A 72-year-old female presents to your office with a 12-month old painful nonunion of a 2-part (surgical neck) proximal humerus fracture which was managed non-operatively. Prior to her injury, she denied shoulder pain and had excellent range of motion. Since the injury, she has had persistent debilitating pain and dysfunction with motion above the shoulder level. X-Rays show good bone stock, no significant shoulder arthritis or avascular necrosis, and well-positioned tuberosities. Which of the following is the most optimal treatment for the patient?
Closed reduction and percutaneous pinning
Open bone grafting
Open reduction and internal fixation (ORIF) with or without bone grafting
Reverse total shoulder arthroplasty (rTSA) with lattisimus dorsi transfer to assist with internal rotation
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A 69-year-old male sustained a proximal humerus fracture that underwent open reduction and internal fixation nine months ago. He complains of constant pain and weakness; repeat radiographs are shown in Figures A and B. What is the most appropriate surgical treatment at this time?
Revision open reduction and internal fixation
Valgus corrective osteotomy of proximal humerus
Humeral head resection
A 24-year-old female sustains a surgical neck proximal humerus fracture in a motor-vehicle collision. She undergoes open reduction and internal fixation but heals in 45 degrees of varus and has significant limitation of shoulder range of motion despite 9 months of conservative treatments. What is the most appropriate treatment at this time?
Manipulation under anesthesia
Humeral head resurfacing
Revision open reduction internal fixation with osteotomy
Reverse total shoulder arthroplasty