Threepart proximal humeral fracture Case for small group

$Three-part proximal humeral fracture Case for small group discussion: Upper extremity fractures—decision making and$

Case description • 61 -year-old man • Simple fall on the floor • Neurovascular

$Three-part fracture of proximal humerus nailing • Nonoperative treatment: sling • X-ray after 1$

Intraoperative x-rays • Intramedullary nail • Deltoid split approach Day 8

6 months Elevation 170° (100% opp. site) Strength 80% Pain in full elevation ?

6 months • Surgery was indicated—partial implant removal: 2 locking head screws • After

1 year • Physiotherapy: 20 weeks • Absolute Constant score 96 pts • Relative

5 years • Full performance • Absolute Constant score 98 pts • Relative Constant

$Summary and take home message • Priorities in three-part fractures include both reduction of$

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$Three-part proximal humeral fracture Case for small group discussion: Upper extremity fractures—decision making and$

Three-part proximal humeral fracture Case for small group discussion: Upper extremity fractures—decision making and methods of stabilization AO Trauma Advanced Principles Course

Case description • 61 -year-old man • Simple fall on the floor • Neurovascular status ok • Nondominant arm • Very active Day 0

$Three-part fracture of proximal humerus nailing • Nonoperative treatment: sling • X-ray after 1$

Three-part fracture of proximal humerus nailing • Nonoperative treatment: sling • X-ray after 1 week • Change of treatment strategy ? Day 7

Intraoperative x-rays • Intramedullary nail • Deltoid split approach Day 8

6 months Elevation 170° (100% opp. site) Strength 80% Pain in full elevation ?

6 months • Surgery was indicated—partial implant removal: 2 locking head screws • After screw removal pain diminished

1 year • Physiotherapy: 20 weeks • Absolute Constant score 96 pts • Relative Constant score 96% • No pain Evaluation of functional result ? Long-term result ? Risks ?

5 years • Full performance • Absolute Constant score 98 pts • Relative Constant score 98% • No pain

$Summary and take home message • Priorities in three-part fractures include both reduction of$

Summary and take home message • Priorities in three-part fractures include both reduction of the head fragment, and reduction and fixation of the tuberosity. • Specially designed IM nails may provide sufficient stability for these fractures, with suture augmentation for tuberosity. • Reduction and nail entry point are critical to functional outcome. • If necessary, partial implant removal can be performed.