Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus 11-C3.2 Open reduction; plate fixation

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Glossary

1 Principles top

Emergency treatment enlarge

Emergency treatment

In C3.2 fractures there is a glenohumeral dislocation. 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.


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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.


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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

After reduction of the glenohumeral dislocation, the C3.2 fracture becomes either a C1.1 or C1. 2 fracture (with intact periosteal sleeve), or a C2.1 or C2.2 fracture (with disrupted periosteal sleeve).


C1.1 Cephalotubercular fracture with valgus malalignment enlarge

C1.1 Cephalotubercular fracture with valgus malalignment (with intact periosteal sleeve)

Select this fracture configuration.


C1.2 Cephalotubercular fracture with varus malalignment enlarge

C1.2 Cephalotubercular fracture with varus malalignment (with intact periosteal sleeve)

Select this fracture configuration.


C2.1 Cephalotubercular fracture with valgus malalignment enlarge

C2.1 Cephalotubercular fracture with valgus malalignment (with disrupted periosteal sleeve)

Select this fracture configuration.


C2.2 Cephalotubercular fracture with varus malalignment enlarge

C2.2 Cephalotubercular fracture with varus malalignment (with disrupted periosteal sleeve)

Select this fracture configuration.

v2.0 2011-05-02