Technical factors may influence outcomes in management of proximal humerus fractures
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Key takeaways:
- Suture augmentation can provide fixation in proximal humerus fractures.
- Surgeons can eliminate screw cutout by cascading screws, keeping the longest screw to the calcar and removing any protruding screws.
WAILEA, Hawaii — When it comes to proximal humerus fractures, a presenter here said that not all patients will benefit from surgery, good fracture reduction is needed even with locked plating and the first procedure matters.
“If you do an internal fixation [and] that fails [and] you do a reverse, the outcomes of that reverse are never as good as if you had done a reverse on the initial setting,” Mark A. Mighell, MD, said in his presentation at Orthopedics Today Hawaii.
Mighell also said suture augmentation acts as a tension band construct and helps provide fixation, while impacting the shaft into the head provides a larger surface area for healing.
“You may shorten it 5 mm to 10 mm but, at the end of the day, having that large surface area for healing is important, and you are less likely to have the fracture fall into varus,” Mighell said.
Impaction or a structural graft is needed to reduce any gaps, which will lead to failure, according to Mighell. He added that surgeons need to eliminate screw cutout to avoid destruction of the glenoid. To eliminate screw cutout, Mighell said to cascade screws, keep the longest screw to the calcar and remove any screws protruding into the joint.
“I like the idea of a blunt screw [better] than a sharp screw because if you get a blunt screw that cuts out, it is not going to cause as much damage to the glenoid,” Mighell said.
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Mighell MA. Treating the proximal humerus: Five tips in 5 minutes. Presented at: Orthopedics Today Hawaii; Jan. 7-11, 2024; Wailea, Hawaii.
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