case presentation: three-part proximal humerus fractures...case presentation: three-part proximal...
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![Page 1: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/1.jpg)
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Case Presentation: Three-Part Proximal Humerus
Fractures
Mark A. Mighell, MD
Kaitlyn N. Christmas, BS
Mark A. Mighell, MD
Kaitlyn N. Christmas, BS
Case Example #1: 3-Part FractureCase Example #1: 3-Part Fracture
• 35-year-old male presents to clinic with limited ROM due to pain after an ATV accident
• History significant for brachial plexopathy, obesity, large hematoma of his left upper extremity
What would you do?
POLL OPEN
1. Nonoperative Treatment0%
2. ORIF0%
3. Hemiarthroplasty0%
4. RSA0%
![Page 2: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/2.jpg)
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Case Example #1: 3 Months S/P ORIFCase Example #1: 3 Months S/P ORIF
Case Example #2Case Example #2
• 64-year-old retired male presents to clinic with pain after suffering a ground level fall
• History is significant for high cholesterol and prostate cancer
What would you do?
POLL OPEN
1. Nonoperative Treatment0%
2. ORIF0%
3. Hemiarthroplasty0%
4. RSA0%
![Page 3: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/3.jpg)
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Case Example #2: 3 Weeks PostOpCase Example #2: 3 Weeks PostOp
Case Example #2: 10 Months PostOpCase Example #2: 10 Months PostOp
• Forward Flexion: 120°•Abduction: 100°
• External Rotation: 75°• Internal Rotation: T6
Deforming ForcesDeforming Forces
• Unopposed pull of the subscapularis
•Greater tuberosity displaced posterior-superior
• Shaft displaced anterior-medial
![Page 4: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/4.jpg)
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Reduction ManeuverReduction Maneuver
•De-rotate head
Management of 3-Part FracturesManagement of 3-Part Fractures
•Reduce the head to shaft with K-wires
•Reduce greater tuberosity with heavy sutures and pin to shaft
Case Example #1: 3-Part FractureCase Example #1: 3-Part Fracture• 78-year-old female is
assaulted and purse snatched
• Degloving injury – leg requires muscle flap
![Page 5: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/5.jpg)
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IntraOpIntraOp
IntraOpIntraOp
Reduction PearlReduction Pearl•Head can be pinned to the glenoid to assist reduction
![Page 6: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/6.jpg)
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Reduction PearlReduction Pearl•Head can be pinned to the glenoid to assist reduction
IntraOpIntraOp
FinishedFinished
![Page 7: Case Presentation: Three-Part Proximal Humerus Fractures...Case Presentation: Three-Part Proximal Humerus Fractures Mark A. Mighell, MD Kaitlyn N. Christmas, BS Case Example #1: 3-Part](https://reader030.vdocument.in/reader030/viewer/2022041016/5ec8b4eb01148314424233f4/html5/thumbnails/7.jpg)
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FinishedFinished
Thank You