1 Principles top
Anatomical reduction and stable fixation, best provided by angular stable plating, should be considered as the first choice for patients with satisfactory bone quality and higher functional expectations.
A deltopectoral approach is almost always required for glenohumeral reduction.
In some cases, neurovascular compromise results from fracture fragment displacement. If this is the case, emergency treatment is necessary. Otherwise, definitive reduction and fixation can be done after suitable preparations, but without prolonged delay.
If open treatment will be delayed, closed reduction of the glenohumeral dislocation can be attempted.
2 Glenohumeral reduction topenlarge
First of all, a reduction of the glenohumeral dislocation should be performed. In cases of undisrupted periosteal sleeves, this might be done in a closed manner (as illustrated). If the periosteal sleeve is disrupted, an open reduction of the glenohumeral dislocation becomes more likely. In these cases, it might become necessary to perform an arthrotomy to the glenohumeral joint via either an osteotomy of the lesser tuberosity or tenotomy of the subscapularis tendon.
Use a deltopectoral approach.
With longitudinal traction applied to the arm, the dislocated humeral head may be reduced using direct digital pressure pushing it back into position.
Option: bone hook
A bone hook can be placed carefully around the calcar avoiding damage to the articular cartilage. The head can then be pulled laterally and guided into position. Note: avoid neurovascular injury.
3 Fracture fixation following glenohumeral reduction top
Once the dislocation is reduced the fracture pattern may be reassessed and appropriate treatment may be planned.