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

The treatment of proximal humerus fractures with impacted varus displacement requires precise anatomic restoration, achievement of 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 locking 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 in proximal humerus fractures. Management of two-part fractures with impacted varus deformity. Anatomical exposure and preservation of soft tissues. Tenotomy and tenodesis of the long head of the biceps. Amarrage and marionette reduction techniques. Use of Kirschner wires and Steinmann wires. Positioning and adjustment of the proximal locking plate. Medial calcar fixation and structural support. Complementary stabilization of the rotator cuff. Use of bone graft as augmentation. Radiographic control and final assessment of reduction. DETAILED CONTENT Structured Surgical Planning: Definition of the operative strategy based on CT scan analysis, identification of deformities, and planning of the reduction sequence. Anatomic Deltopectoral Approach: Access technique with identification of anatomical intervals, wide bone exposure, and preservation of muscular and vascular structures. Soft Tissue Preservation: Strategies to maintain an intact deltoid, protect the cephalic vein, and reduce soft tissue trauma. Anatomy-Guided Reduction: Practical application of anatomical landmarks such as the bicipital groove, fracture apexes, and rotator cuff alignment. Marionette Technique and Rotator Cuff Traction: Methods for controlled manipulation of fragments aiming to restore anatomical alignment. Strategic Use of Auxiliary Wires: Application of Kirschner and Steinmann wires for temporary 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 manipulation. Medial Calcar Fixation: Biomechanical application of medial support for varus control and increased osteosynthesis stability. Complementary Rotator Cuff Stabilization: Tuberosity suture techniques to reinforce functional stability of the proximal humerus. Bone Graft Augmentation: Application of structural support between screws to improve humeral head support. INCLUDED MATERIAL Detailed PDF: The PDF presents a complete fracture analysis, CT-based surgical planning, step-by-step operative sequence, biomechanical principles applied to impacted varus reduction, implant positioning, use of auxiliary wires, and an objective discussion of intraoperative decisions related to mechanical stability and anatomic reconstruction. Enhance your decision-making in proximal humerus fractures and incorporate reduction and stabilization strategies applicable to daily surgical practice.