Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus 4-Part, dislocation, simple metaphyseal, intact articular

back to skeleton

Glossary

1 Principles top

Introduction

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.


Emergency treatment enlarge

Emergency treatment

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 top

First of all, a reduction of the glenohumeral dislocation should be performed. In cases of undisrupted periosteal sleeves, ... enlarge

Closed

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.


enlarge

Open

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.


enlarge

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.


4-part fracture, slight displacement, intact articular surface, valgus malalignment enlarge

4-part fracture, slight displacement, intact articular surface, valgus malalignment

Select this fracture configuration.


4-part fracture, slight displacement, intact articular surface, varus malalignment enlarge

4-part fracture, slight displacement, intact articular surface, varus malalignment

Select this fracture configuration.


4-part fracture, marked displacement, intact articular surface, valgus malalignment enlarge

4-part fracture, marked displacement, intact articular surface, valgus malalignment

Select this fracture configuration.


4-part fracture, marked displacement, intact articular surface, varus malalignment enlarge

4-part fracture, marked displacement, intact articular surface, varus malalignment

Select this fracture configuration.

v2.0 2011-05-02