OrthoNet

Proximal Humerus Fractures

Usually treated closed

Expect lots of remodeling

As the child approaches skeletal maturity, you’ve gotta be abit more careful
- over age 11: angulation less then 20 degrees, displacement less than 50% is acceptable

- if you need to reduce, do it in the OR, and fix with K-wires

Open reduction should be reserved for vascular injury, open injury, or fracture dislocations (do not try reducing a glenohumeral dislocation with a proximal humerus fracture - you may nail the artery or nerve)

If Vascular Injury - the goal is proximal and distal control.
- deltopectoral approach, curved over clavicle proximally
- must take off pec major with something to repair back to later - this gives you much better exposure
- the artery is behind pec minor proximally - drill, measure, then tap the coracoid and osteotomize it.
- even more proximally, need to osteotomize the clavicle