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Subscapularis Peel for Open Reduction and Internal Fixation of Proximal Humerus Fractures With a Head Split

Cherney, Steven M., MD*; Murphy, Ryan A., MD; Achor, Timothy S., MD; Choo, Andrew M., MD

doi: 10.1097/BOT.0000000000001275
Technical Trick

Summary: Proximal humerus fractures involving an articular head split are rare and complex injuries. In the elderly population, arthroplasty is the optimal treatment, whereas in younger patients, the utility of arthroplasty procedures is limited by concerns of long-term implant survival. As a result, open reduction and internal fixation is still often the first-line treatment option for head-splitting injuries. The traditionally described deltopectoral or anterolateral surgical approaches to the proximal humerus rely on indirect reduction and limited visualization of the articular fragments. We present a case series of younger patients with head-split proximal humerus fractures treated with open reduction and internal fixation through a deltopectoral approach with a subscapularis peel to improve humeral head visualization, reduction, and fixation. The improved reduction may lead to better long-term outcomes and reduce the need for additional surgical procedures. In addition, there were no cases of avascular necrosis in this series.

*Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR; and

Department of Orthopaedic Surgery, McGovern Medical School at UTHealth, Houston, TX.

Reprints: Andrew M. Choo, MD, Department of Orthopaedic Surgery, McGovern Medical School at UTHealth, 6400 Fannin St. Suite 1700, Houston, TX 77030 (e-mail: andrew.m.choo@uth.tmc.edu).

T. S. Achor is a paid consultant to Synthes. The remaining authors report no conflict of interest.

Accepted June 26, 2018

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