Missed GT and LT Fractures:<\/strong>\u00a0GT fractures are often posteriorly displaced and may appear minimally displaced on AP radiographs. Impacted LT fractures commonly occur with posterior dislocations. Obtain axillary and transscapular radiographs and consider CT scans to accurately assess these fractures.<\/p>\n\n\n\n Ignoring Physiologic Age:<\/strong>\u00a0Consider the patient\u2019s physiologic age (activity level and demands) when making surgical decisions. A healthy, highly active elderly patient may benefit more from surgery than a younger, unhealthy, inactive patient.<\/p>\n\n\n\n Axillary Nerve Injury:<\/strong>\u00a0The axillary nerve is at risk during both deltopectoral and deltoid split approaches. Identify and protect the nerve during dissection, retractor placement, and plate application to avoid injury.<\/p>\n\n\n\n Subacromial Impingement:<\/strong>\u00a0When fixing GT fractures with screws, keep implants low on the tuberosity to avoid subacromial impingement with shoulder motion.<\/p>\n\n\n\n High Plate Placement:<\/strong>\u00a0The most common error with plate fixation is placing it too high on the proximal humerus. This can cause subacromial impingement. Ensure the plate is positioned low to avoid this complication.<\/p>\n\n\n\n Drilling Through the Articular Surface:<\/strong>\u00a0Do not drill through the articular surface of the humeral head. This increases the risk of screw penetration into the joint and can lead to varus collapse and arthritis.<\/p>\n\n\n\n Inadequate Tuberosity Fixation:<\/strong>\u00a0Poor fixation of the tuberosities can lead to malunion, nonunion, and loss of shoulder function. Use a combination of screws, sutures, and\/or tension band constructs to achieve secure fixation, paying attention to the quality of bone.<\/p>\n\n\n\n Intramedullary nailing of proximal humeral fractures<\/strong><\/p>\n\n\n\n Medullary Canal Breach:<\/strong>\u00a0Breaching the medullary canal can lead to neurovascular injury or misplacement\/migration of the nail. Use gentle technique and follow the natural curvature of the humerus with awls and reamers.<\/p>\n\n\n\n Inadequate Medial Nail Insertion:<\/strong>\u00a0Ensure the nail is inserted sufficiently into the medial fragment (at least 5 cm past the fracture) to provide adequate stability. Failure to do so can compromise fixation and lead to nonunion.<\/p>\n\n\n\n Prominent Nail Proximally:<\/strong>\u00a0Avoid a prominent nail proximally, as this can cause rotator cuff irritation and subacromial impingement. Ensure the nail is appropriately countersunk.<\/p>\n\n\n\n Misaligned\/Errant Reaming:<\/strong>\u00a0Reaming should be performed with the fracture anatomically reduced and aligned. Any varus or translational malalignment during reaming will result in a similar deformity when the nail is inserted.<\/p>\n\n\n\n Distal Cortex Penetration:<\/strong>\u00a0Avoid penetrating the distal humeral cortex with the nail, especially in osteoporotic bone. This can cause iatrogenic distal humeral fracture or pain. Choose the shorter of two nail lengths if unsure.<\/p>\n\n\n\n Screw Penetration:<\/strong>\u00a0Avoid penetrating the subchondral bone of the humeral head with locking screws. This can lead to head collapse and screw protrusion into the joint.<\/p>\n\n\n\n Inadequate Proximal Screw Fixation:<\/strong>\u00a0Use maximal (three to four) screw fixation rather than minimal screw fixation in the proximal humerus to provide better stability, particularly in osteoporotic bone.<\/p>\n\n\n\n Disclaimer: Like and share, your hands will be left with the fragrance!<\/p>\n\n\n\n <\/p>","protected":false},"excerpt":{"rendered":" Proximal humeral fractures are very common in orthopedic clinical practice. This article will discuss several major pitfalls that need to be noted in open reduction and internal fixation and intramedullary nailing of proximal humeral fractures, aiming to provide guidance for young orthopedic surgeons to optimize surgical outcomes and reduce postoperative complications. Open reduction and internal […]<\/p>","protected":false},"author":1,"featured_media":1705,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_seopress_robots_primary_cat":"none","_seopress_titles_title":"Avoiding Pitfalls in Proximal Humeral Fracture Surgery","_seopress_titles_desc":"Discover essential tips for young orthopedic surgeons to optimize outcomes and reduce complications in proximal humeral fracture surgery. Learn about managing greater and lesser tuberosity fractures, considering patient age, avoiding axillary nerve injury, and ensuring proper implant positioning.","_seopress_robots_index":"","footnotes":""},"categories":[1],"tags":[109,106,110,105,104,28,100,103,108,107],"class_list":["post-1702","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-axillary-nerve-injury","tag-fracture-management","tag-fracture-rehabilitation","tag-intramedullary-nailing","tag-open-reduction-internal-fixation","tag-orthopedic-surgery","tag-postoperative-complications","tag-proximal-humeral-fracture","tag-shoulder-surgery","tag-young-orthopedic-surgeons"],"acf":[],"meta_box":[],"_links":{"self":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/1702"}],"collection":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/comments?post=1702"}],"version-history":[{"count":1,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/1702\/revisions"}],"predecessor-version":[{"id":1707,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/posts\/1702\/revisions\/1707"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/media\/1705"}],"wp:attachment":[{"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/media?parent=1702"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/categories?post=1702"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/suzhouyoubest.com\/zh\/wp-json\/wp\/v2\/tags?post=1702"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"https:\/\/suzhouyoubest.com\/wp-content\/uploads\/2024\/09\/0916-1.webp\")
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