The advent of proximal humeral locking plates led to increased enthusiasm and utilization in the setting of open reduction and internal fixation (ORIF) of displaced proximal humerus fractures (PHFs). Received: 23 April 2020 Accepted: Published: 15 April 2021. Keywords: Shoulder fracture proximal humerus fracture (PHF) reverse total shoulder arthroplasty (rTSA) open reduction and internal fixation (ORIF) In very rare cases, fusion may be needed. Ensuring appropriate component position, as well as healing of the tuberosities will improve functional outcomes and decrease complications of rTSA. For the majority of patients, revision to reverse total shoulder arthroplasty (rTSA) will be the most reliable treatment option. In select young patients with an intact rotator cuff, hemiarthroplasty may be a viable option. In young patients with preserved bone stock and humeral head anatomy, revision open reduction, internal fixation can be contemplated. Issues with any of these will define management options. Special attention needs to be paid to axillary nerve function, bone loss, rotator cuff function, and infection. Obtaining outside operative reports can help clarify decision making of previous surgeons. This includes patient history, physical exam, plain film radiographs, CT scans, and in some cases further advanced testing (EMG and/or aspiration). In the setting of failure, a thorough workup is needed to evaluate causes of failure and treatment options. Appropriate patient selection, a principle-based surgical technique, and conservative postoperative restrictions can help minimize failures. Failure rates, however, remain high, particularly in elderly patients with complex and severe PHFs. Abstract: The introduction of fixed angle locking plates increased the frequency and reliability of fixation of proximal humerus fractures (PHFs).
0 kommentar(er)
