PROXIMAL HUMERUS [Case 6] · Two-Part · Plate and Screws

The treatment of displaced varus-impacted proximal humerus fractures requires precise anatomical restoration, adequate mechanical stability, and mastery of reduction maneuvers to correct medial collapse.

This training presents the complete management of a two-part proximal humerus fracture using a deltopectoral approach associated with locked plate osteosynthesis, application of rotator cuff traction reduction techniques, auxiliary wires, and biomechanical strategies for varus correction, demonstrated in detail from a surgical perspective.

TRAINING FOCUS

• Deltopectoral approach and anatomical landmarks.
• Surgical planning for proximal humerus fractures.
• Management of two-part varus-impacted fractures.
• Anatomical exposure and soft tissue preservation.
• Tenotomy and tenodesis of the long head of the biceps.
• Suture-loop and marionette reduction techniques.
• Use of Kirschner wires and Steinmann pins.
• Positioning and adjustment of the proximal locked plate.
• Medial calcar fixation and structural support.
• Complementary rotator cuff stabilization.
• Use of bone graft as augmentation.
• Radiographic control and final reduction assessment.

DETAILED CONTENT

• Structured Surgical Planning: Definition of the operative strategy based on CT analysis, identification of displacements, and planning of the reduction sequence.
• Anatomical Deltopectoral Approach: Access technique with identification of anatomical intervals, wide bone exposure, and preservation of muscular and vascular structures.
• Soft Tissue Preservation: Strategies for maintaining an intact deltoid, protecting the cephalic vein, and reducing tissue trauma.
• Anatomical Landmark-Guided Reduction: Practical application of anatomical parameters such as the bicipital groove, fracture vertices, and rotator cuff alignment.
• Marionette Technique and Cuff Traction: Methods for controlled manipulation of fragments aiming at restoring anatomical alignment.
• Strategic Use of Auxiliary Wires: Application of Kirschner wires and Steinmann pins for provisional stabilization, mechanical leverage, and reduction control.
• Plate Positioning and Implant Control: Adjustment of plate height, prevention of subacromial impingement, and maintenance of stability during intraoperative manipulations.
• Medial Calcar Fixation: Biomechanical application of medial support to control varus and increase osteosynthesis stability.
• Complementary Rotator Cuff Stabilization: Tuberosity suture-loop techniques for reinforcing the functional stability of the proximal humerus.
• Augmentation with Bone Graft: Application of complementary structural support between screws to improve humeral head support.

INCLUDED MATERIAL

Detailed PDF: The PDF presents a complete fracture analysis, CT-based surgical planning, sequence of operative steps, biomechanical principles applied to varus-impacted reduction, implant positioning, use of auxiliary wires, and objective discussion of intraoperative decisions related to mechanical stability and anatomical reconstruction.

Deepen your decision-making in proximal humerus fractures and incorporate reduction and stabilization strategies applicable to daily surgical practice.