proximal humerus fracture management lecture

Video Description

- I will talk today about proximal humerus fracture management.
- anatomy of proximal humerus fracture: The proximal humerus arises from four distinct centers of ossification: the humeral head, the greater tuberosity, the lesser tuberosity, and the shaft. The humeral head is retroverted approximately 30 degrees. The greater tuberosity has three distinct facets for the insertion of the supraspinatus, the infraspinatus, and the teres minor muscles of the rotator cuff. The lesser tuberosity is the insertion site for the subscapularis muscle. rotator interval lies between the upper subscapularis and the anterior border of the supraspinatus.The anterior humeral circumflex artery branch from axillary artery and courses laterally along the inferior subscapularis. The posterior circumflex humeral artery branches from the axillary artery, travels through the quadrangular space with the axillary nerve, winds superolaterally around the posterior aspect of the humerus, and supplies the superior, lateral, and inferior aspects of the humeral head.


-Predictor of ischemia:Metaphyseal extension is the measured distance from the head–neck junction to the inferior extent of the medial cortex. (A) Metaphyseal extension greater than 8 mm. (B) Metaphyseal extension less than 8 mm. The medial hinge is evaluated at the medial calcar. (non displaced and displace)



-PATHOGENESIS: bimodal distribution fractures of senescence


- Neer Classification


- Valgus impacted Although not included in Neer's original classification, valgus impacted fractures are a unique entity that is important to recognize. Four-part fractures in which the humeral articular surface is impacted on the shaft segment in a valgus position, leading to an increase in the angle between the humeral shaft and the articular surface



-NATURAL HISTORY: Eighty-five percent of proximal humerus fractures can be treated nonoperatively.


- PATIENT HISTORY AND PHYSICAL FINDINGS: ALTS + Pay particular attention to axillary nerve function as injuries are common
- IMAGING AND OTHER DIAGNOSTIC STUDIES: The series includes an (AP) view of the shoulder, a scapular AP view, a scapular Y view, and an axillary view + Computed tomography (CT)

- Combined cortical thickness



- NONOPERATIVE MANAGEMENT: 85% of proximal humerus fractures are minimally displaced and can be treated nonoperatively



- Surgical options: 1-Closed reduction percutaneous pinning. 2- ORIF by PHILOS. 3-INM 4- Hemiarthroplasty / Reverse shoulder arthroplasty.
-COMPLICATIONS: Screw pullout Screw penetration Pin migration Nerve injury Malunion Nonunion



-orthopedic surgery lecture
-please do not hesitate to ask dr ahmed elattar