Proximal Humerus Fracture: Orthopedic MD Explains Treatment & Management

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    Clinical Case: Proximal Humerus Fracture Fixation
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    <div markdown="1" style="margin-top: 10px; font-size: 0.85rem; color: #64748b;">AP and Axillary Lateral Views of the Shoulder</div>
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            <span class="ev7-acc-title">Describe these radiographs and provide your classification.</span>
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            <p>These are AP and axillary lateral radiographs of a skeletally mature patient. They demonstrate a <strong>displaced proximal humerus fracture</strong>. Specifically, there appears to be a 3-part fracture pattern (according to <strong>Neer's Classification</strong>) involving the greater tuberosity and the surgical neck. There is significant varus angulation of the humeral head (~20 degrees) and medialization of the shaft.</p>
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                <strong>Neer Definition:</strong> A part is defined as displaced if there is >1cm translation or >45° angulation.
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            <p>In a 55-year-old active patient, my preference is for <strong>Open Reduction and Internal Fixation (ORIF)</strong> with a proximal humerus locking plate. While the <strong>PROFHER trial</strong> suggests that non-operative management may yield similar results at 2 years for many patients, this specific fracture has varus displacement and tuberosity involvement, which increases the risk of subacromial impingement and poor functional outcomes if allowed to heal in malunion.</p>
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                <li><strong>Initial:</strong> Sling immobilization, analgesia, and neurovascular assessment (Axillary nerve).</li>
                <li><strong>Surgical Goal:</strong> Restore the neck-shaft angle (135°) and anatomical tuberosity position.</li>
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            <p>I would use a <strong>Deltopectoral approach</strong> in the beach-chair position. The cephalic vein is retracted laterally with the deltoid. I would identify the biceps tendon as a landmark for the interval between the tuberosities.</p>

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                            <th>Category</th>
                            <th>Specific Complication</th>
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                        <tr><td>Neurological</td><td>Axillary nerve injury (during lateral dissection/retraction)</td></tr>
                        <tr><td>Vascular</td><td>Osteonecrosis (AVN) of the humeral head</td></tr>
                        <tr><td>Mechanical</td><td>Screw cutout (especially in osteoporotic bone) or Varus collapse</td></tr>
                        <tr><td>Long-term</td><td>Shoulder stiffness / Adhesive capsulitis</td></tr>
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