11/28/2017 1 Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part Fracture Case Example #1: 3-Part Fracture • 35-year-old male presents to clinic with limited ROM due to pain after an ATV accident • History significant for brachial plexopathy, obesity, large hematoma of his left upper extremity What would you do? POLL OPEN 1. Nonoperative Treatment 0% 2. ORIF 0% 3. Hemiarthroplasty 0% 4. RSA 0%
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11/28/2017
1
Case Presentation: Three-Part Proximal Humerus
Fractures
Mark A. Mighell, MD
Kaitlyn N. Christmas, BS
Mark A. Mighell, MD
Kaitlyn N. Christmas, BS
Case Example #1: 3-Part FractureCase Example #1: 3-Part Fracture
• 35-year-old male presents to clinic with limited ROM due to pain after an ATV accident
• History significant for brachial plexopathy, obesity, large hematoma of his left upper extremity
What would you do?
POLL OPEN
1. Nonoperative Treatment0%
2. ORIF0%
3. Hemiarthroplasty0%
4. RSA0%
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Case Example #1: 3 Months S/P ORIFCase Example #1: 3 Months S/P ORIF
Case Example #2Case Example #2
• 64-year-old retired male presents to clinic with pain after suffering a ground level fall
• History is significant for high cholesterol and prostate cancer
What would you do?
POLL OPEN
1. Nonoperative Treatment0%
2. ORIF0%
3. Hemiarthroplasty0%
4. RSA0%
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Case Example #2: 3 Weeks PostOpCase Example #2: 3 Weeks PostOp
Case Example #2: 10 Months PostOpCase Example #2: 10 Months PostOp
• Forward Flexion: 120°•Abduction: 100°
• External Rotation: 75°• Internal Rotation: T6
Deforming ForcesDeforming Forces
• Unopposed pull of the subscapularis
•Greater tuberosity displaced posterior-superior
• Shaft displaced anterior-medial
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Reduction ManeuverReduction Maneuver
•De-rotate head
Management of 3-Part FracturesManagement of 3-Part Fractures
•Reduce the head to shaft with K-wires
•Reduce greater tuberosity with heavy sutures and pin to shaft
Case Example #1: 3-Part FractureCase Example #1: 3-Part Fracture• 78-year-old female is
assaulted and purse snatched
• Degloving injury – leg requires muscle flap
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IntraOpIntraOp
IntraOpIntraOp
Reduction PearlReduction Pearl•Head can be pinned to the glenoid to assist reduction
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Reduction PearlReduction Pearl•Head can be pinned to the glenoid to assist reduction
IntraOpIntraOp
FinishedFinished
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FinishedFinished
Thank You
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