Plate, and based on image intensification in two planes, a guide wire A locking drill sleeve is threaded into the Insert the locking screws into the head, a triple drill guide is Lightly tightened and adjusted (as judged through fluoroscopy). 3.13).Ī standard cortical screw is placed in the oval hole in the plate, Image intensifier to insure that the plate is not prominent superiorly ( Fig. The height of the plate is evaluated with the Schantz pin may be used as a joystick to help reduce and/or stabilize In the case of a displaced humeral head, a Kirschner (K) wire or Imaging, is reduced with manipulation via blunt elevators or joysticks ( Fig. The humeral head, as visualized via fluoroscopic Soft-tissueĪttachments should be maintained, but when needed, the rotator interval Sutures should be placed in the tendinous insertions to hold and reduceįragments most securely ( Fig. Tuberosity however, this type of dated injury is uncommon. In patients with fractures more than 2 weeks old, a small, lateral,ĭeltoid split can be performed to retrieve and repair the greater Often displaced posteriorly and can be retrieved with the arm abducted. The subscapularis and supraspinatus tendons. Heavy nonabsorbable sutures are placed in The long head of the biceps tendon is the key landmark for The fracture fragments are atraumatically identified andĮxposed. (arcuate) branch of the anterior, humeral, circumflex artery that is Of the fracture, one should keep in mind that important vascularĬontributions to the articular segment are made by the ascending During the initial exposure and mobilization Tendon, and the greater tuberosity and supraspinatus tendon insertionĪre lateral to the biceps. The lesser tuberosity and subscapularis tendon lie medial to the biceps Should be identified next because it defines the rotator cuff interval. Theĭeltopectoral interval is deepened bluntly to the clavipectoral fascia.ĭuring deep dissection, an important landmark is the coracoid processĪnd its associated strap muscles. Most vulnerable to injury in the proximal part of the incision. The vein marks the location of theĭeltopectoral interval ( Fig. The skin and subcutaneous tissues are divided,Īnd the cephalic vein is identified. The skin may be infiltrated with local anesthetic andĮpinephrine if desired.
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