1 Principles topenlarge
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 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
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).