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Reduction and preliminary fixation

Goals of reduction

The goal of reduction is to restore the normal location of all fracture components. For B2.1 and B2.2 fractures, the humeral head and separated tuberosity must be reduced properly.

The optimal reduction and fixation procedure for the B2 fracture subtypes depends on the involved tuberosity, and whether or not the calcar region is comminuted.

Proximal humeral reconstruction

  1. Reduce and fix the lesser/greater tuberosity to the humeral head (thereby converting the 3-part fracture into a 2-part situation)
  2. Reduce the metaphyseal fracture component to the shaft and fix it

In the following procedure, involvement of the greater tuberosity is assumed. For details for proper reduction in cases of lesser tuberosity involvement, please click here.

Metaphyseal comminution
In B2.3 fractures (with medial metaphyseal comminution), it is necessary to realign the medial column fragments as accurately as possible while preserving their soft-tissue attachments and vascularity. Once healed, the restored medial bony buttress helps prevent varus collapse. With medial comminution, initial fixation must be secure enough to resist varus collapse.
It is also crucial to reduce the humeral head adequately since the combination of remaining varus displacement and medial comminution predisposes to secondary varus collapse and/or implant failure.