Proximal humerus fracture - dislocation

The following case is a patient that was seen in the office after a fall from height. He is a 25 year old male who presented with pain to his R shoulder in the  ER and diagnosed with a proximal humerus fracture dislocation. Closed reduction performed by the ER physicians. He seen in our office and reported pain to the R shoulder, denied elbow or hand pain, denied numbness or tingling to the hand.

The preop images demonstrate a significant size greater tuberosity fracture with comminution. Most shoulder surgeons will agree that an anterior traumatic shoulder dislocation as demonstrated in this case is associated with a Hill Sachs lesion and that a fracture of the great tuberosity is rare.

This patient underwent ORIF of the fracture through a deltopectoral approach without detachement of the deltoid. The alternative approach would have been an extensile U shaped incision just lateral to the acromion with a takedown of the deltoid to access the posterosuperior aspect of the humeral head where the fracture is most often located. The disadvantage of this approach is that detachment of the deltoid can cause malfunction of the muscle in addition to higher chances of axillary nerve damage. We selected to use a 3.5 reconstruction plate because it can be contured intraoperatively to match the anatomy of the patient and be positioned in the posterolateral aspect of the humerus where a "typical" locking plate would have been ideal for a lateral side application. In addition, the cost of that plate is significantly less compared to a locking proximal humerus plate.

In this case there were avulsion fractures of the infraspinatus and supraspinatus that required buttressing of these fractures in addition to the repair of the tendon to bone (rotator cuff) with Fiberwire non absorbable sutures.