Proximal Humerus Fracture (Synthes)

Question 1

In proximal humerus fracture ORIF what is the safe zone?

Answer 1

The axillary n. runs from 5cm distal to lateral acromion edge to 7cm distal. Proximal and distal to this corridor is deemed safe.

Question 2

Describe deltopectoral approach?

Answer 2

1) 12-14cm incision from coracoid process to proximal humeral shaft
2) Expose deltopectoral groove and cephalic vein
3) Retract cephalic vein laterally (risk of retractor damage) or medially (must cauterize branches)
4) Bluntly dissect btw the deltoid and pectoralis major
5) Incise the clavipectoral fascia lateral to the conjoined tendon and inferior to coracoacromial lig
6) Partial release of deltoid or pec major insertions can increase exposure

Question 3

Where does the musculocutaneous n. enter the coracobrachialis?

Answer 3

2.5cm distal to tip of coracoid.

Question 4

What are some design features of the Synthes 3.5mm proximal humerus plate?

Answer 4

1) Sits 15mm distal to rotator cuff
2) Shaft sits slightly anterior
3) Posterior buttress for GT
4) 2-14 hole plates
5) 6 proximal locking holes, 2 calcar screws

Question 5

Where should the plate be positioned?

Answer 5

1) AP view: 15mm distal to cuff insertion, allow distal locking screws to be placed in calcar
2) Lateral view: anterior edge of plate directly lateral to bicipital groove

Question 6

What considerations are taken for osteoporotic bone?

Answer 6

1) Just drill lateral cortex

2) screws placed into subchondral bone; ~ 5-8cm from joint surface

Question 7

What size drill is used?

Answer 7

2.8mm drill for 3.5mm screws

Locking screws can be placed under power with 1.5N torque limiting attachment