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The first 25 slides, exactly as they appear. The full deck has 115 content slides.
Orthopaedics
Proximal Humerus Fracture
Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity
What’s inside
9 sections · 115 slides
Overview
- What this deck covers
Applied Anatomy
The building blocks, blood supply and muscle forces
- What is a proximal humerus fracture?
- Codman's four parts
- Neck-shaft angle, retroversion and Codman's four parts
- The two necks and the bony landmarks
- Blood supply to the ball
- Blood supply of the humeral head — the arcuate artery
- Predicting whether the ball will survive
- Signs of preserved humeral head blood supply
- Bone quality and where screws hold
- Head bone density and the calcar plate
- Muscles pull the pieces apart
- Muscle attachments of the proximal humerus
- How fragments displace in 3- and 4-part fractures
- The rotator cuff — engine and anchor
- Function of the rotator cuff
- The long head of biceps — a useful landmark
- Long head of biceps in the intertubercular groove
Mechanism & Classification
How they happen and how we group them
- How these fractures happen
- The Neer classification — the idea
- The Neer classification
- Neer types explained
- Everted, impacted four-part fracture
Assessment
Clinical examination and imaging
- Clinical assessment
- X-ray views
- Radiographic evaluation — standard projections
- Radiographic evaluation — axillary and lateral views
- CT and MRI
- CT and 3-D reconstruction of the fracture
- Split fracture of the head treated by replacement
Surgical Decision-Making
Who to operate on, and with what
- Who needs surgery?
- Operative vs non-operative
- The menu of operations
- Replacement — the fine print
Open Reduction & Plate Fixation
The workhorse operation, step by step
- Positioning and setup
- Beach-chair position and C-arm setup
- Incision and approach
- Surface marking of the deltopectoral incision
- Deltopectoral exposure and the cephalic vein
- Reducing a two-part surgical-neck fracture
- Reduction of a two-part surgical-neck fracture
- Converting a three-part fracture
- Suture reduction to convert 3-part to 2-part
- Realigning the shaft with a guide pin or plate
- Four-part reduction and temporary fixation
- Levering the head fragment into place
- Direct-vision head reduction and K-wire fixation
- K-wire fixation and tuberosity suture reduction
- Temporary K-wire fixation confirmed by fluoroscopy
- Plate fixation technique
- Placement of the proximal humerus plate
- Screw placement and cuff suture augmentation
- Fluoroscopic check — screws and calcar support
- Medial support — the make-or-break
- Reconstructing medial cortical support
- When fixation fails — hard-won lessons
- Repeated failure of a proximal humerus fixation
- Fibula-graft medial support in revision surgery
- Bone shortening to rebuild medial support
- Healing after medial-support revision
- Screw and plate pitfalls
- Correct screw depth and plate height
- A screw driven into the joint — a preventable error
- Postoperative AP and axillary radiographs
- Postoperative rehabilitation
Other Techniques & Replacement
Nails, pins, the support system and prosthetics
- Why elderly fixation still fails
- The anatomical intramedullary support system
- The anatomical intramedullary support system
- Four-part fracture fixed with the support system
- Support-system surgical steps
- Shoulder replacement — setup
- Beach-chair position for shoulder replacement
- Replacement technique
- Reattaching tuberosities around the prosthesis
- Cerclage of tuberosities to the prosthesis and shaft
- Replacement — keys to success
- Reverse (trans-shoulder) prosthesis
- The reverse (trans-shoulder) prosthesis
- Fixing an isolated greater tuberosity
- Lateral deltoid-split approach
- Splitting the deltoid to expose the tuberosity
- Suture reduction of the greater tuberosity
- Hollow-screw and tension-band fixation options
- Two lag screws for a greater-tuberosity avulsion
- Closed reduction and percutaneous pinning
- Percutaneous K-wire fixation technique
- Surgical-neck fracture fixed by percutaneous pinning
- Intramedullary nailing
- Intramedullary nail entry and reduction
- Surgical-neck fracture fixed with a nail
Complications & Prevention
What goes wrong, and how to stop it
- Locking-plate complications (Sproul review, 514 cases)
- Preventing varus and screw cut-out
- Head bone density and screw pull-out
- Acromial collision and head necrosis
- Acromial collision from a high plate
- Osteonecrosis after failed cerclage
- Heterotopic ossification
- Heterotopic ossification after fixation
Summary
Pulling it together
- Key takeaways
- Why does an anatomical-neck fracture carry such a poor prognosis?
- How do you keep a locking plate from failing in osteoporotic bone?
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Orthopaedic Trauma Surgery — Volume 1: Upper Extremity