Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus by C. Spross, P. Grueninger, S. Gohil, and M. Dietrich JBJS Essent.

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Presentation transcript:

Open Reduction and Internal Fixation of Fractures of the Proximal Part of the Humerus by C. Spross, P. Grueninger, S. Gohil, and M. Dietrich JBJS Essent Surg Tech Volume 5(3):e15 August 12, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-A Measurement of combined cortical thickness as defined by Tingart et al.18. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The depicted two-part surgical neck fracture has a high fracture line, which means <8 mm of metaphyseal head extension (straight arrow). C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Hydraulic device. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The position of the image intensifier (c-arm), which should be checked prior to surgery to make sure that proper anteroposterior and axial views are possible. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The anatomical landmarks and the incision for the deltopectoral approach have been marked. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Identification of the long biceps tendon, which should be done with minimal dissection whenever possible to avoid destabilizing it. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Heavy stay sutures (number-5 Ethibond) have been placed into the tuberosities for marionette- like reduction control. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Figs. 8-A and 8-B A surgical neck (Neer two-part) fracture in an active sixty-eight-year-old woman with decreased bone quality. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The reduction can be held temporarily with temporary fixation of the head to the shaft with 1.6- mm Kirschner wires, which should be placed anterior to the final plate position. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The plate can be positioned with separate Kirschner wires lateral to the Kirschner wires holding the reduction. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The cortical screw in the long hole can be used first for final reduction of the plate to the shaft, with the Kirschner wires left in place. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Final reduction of a varus fracture with the impacted calcar. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

3D reconstruction of a CT scan. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Axial CT scan showing the substantial impaction of the humeral head in relation to the lesser tuberosity fragment. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Intraoperative anteroposterior c-arm image of the fracture. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The Cobb retractor is placed through the fracture between the tuberosities (second window) with its tip aimed at the calcar. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The plate placed in a position to buttress the greater tuberosity, and the final reduction achieved by compressing the plate to the shaft with use of the long-hole cortical screw. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Final reduction with the plate and screws in place. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Aiming jig for the head screws. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Figs. 15-A and 15-B Primary screw cutout as seen on two intraoperative axial views of a cadaveric shoulder22. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The stay sutures can be used to fix the tuberosities back to each other and to the plate to restore the anterior-posterior force couple. C. Spross et al. JBJS Essent Surg Tech 2015;5:e15 ©2015 by The Journal of Bone and Joint Surgery, Inc.