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