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Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus
C Spross1, P Grueninger2, S Gohil1
1Department of Orthopaedic Trauma, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch (Western Australia) 6150, Australia.
Introduction:
We describe the surgical technique for open reduction and internal fixation (ORIF) of proximal humeral fractures with a locking plate.
Step 1 Preoperative Planning:
To choose the right candidate, obtain a full understanding of the patient's fracture pattern, activity level and demands, and bone quality; be aware of predictors of complications and poor outcomes.
Step 2 Patient Positioning:
Place the patient in the beach-chair position with the arm draped free or in a hydraulic device with good access for the image intensifier.
Step 3 Approach:
The deltopectoral approach is generally preferred because of the exposure obtained, the possibility of distal extension, and the minimal risk of nerve injury.
Step 4 Reduction And Fixation Of The Tuberosities The Key To Obtaining Marionette-Like Control:
The control, reduction, and fixation of the tuberosities are crucial to restore the anterior-posterior force couple of the shoulder and must therefore be done properly no matter what the fracture pattern looks like.
Step 5 Fracture Reduction:
After carrying out Steps 1 through 4, perform the reduction techniques for the specific fracture type as described below for types that we think suitable for ORIF with a locking plate.
Step 6 Fixation Implant-Specific Considerations:
Plate length and positioning, humeral head screw placement, distal locking, confirming the screw tip position with the image intensifier, and securing the tuberosities.
Step 7 Tenotomy Or Tenodesis Of The Long Biceps Tendon:
Perform a biceps tenotomy if the biceps is displaced out of the groove by the fracture pattern or if you have to open the rotator interval.
Step 8 Wound Closure:
Do not close the deltopectoral interval.
Step 9 Rehabilitation:
As the failure rate of ORIF of proximal humeral fractures is high, do not force an active rehabilitation protocol.
Results:
In our analysis of 269 fractures followed for twelve months, we found that the Constant-Murley score (CMS) and Short Form-36 (SF-36) score improved continuously during the first six months postoperatively.IndicationsContraindicationsPitfalls & Challenges.
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