Rationale for Patient Selection
- 62-year-old female with right-displaced 3-part fracture from a trip/fall
- Potential complications from lymphedema status post-breast cancer with both radiation and node dissection, which may impact successful healing from open reduction and internal fixation
- Large, minimally displaced greater tuberosity in good position, means less need to perform open reduction
Assessment of Injury
- Images show 100% displacement of the shaft relative to the humeral head
- The greater tuberosity is minimally displaced
- X-rays indicated the presence of staples from previous lymph node dissection
External Fixator Placement
- Total operative time for placement: 40 minutes
- Images show confirmation of closed reduction followed by placement of the first pin in the humeral head to stabilize
- Two additional pins are placed in the humeral head
- Reduction is again confirmed, and two larger pins are placed into the humeral shaft
- The construct is designed to avoid the axillary nerve
- Finally, two additional pins are placed into to the humeral head for a total of five
Post-op Progress
Week 0: External fixation is placed. The patient is sent home with non-weightbearing, no lifting more than 1-pound, active elbow range of motion, passive shoulder range of motion with forward flexion 0-90 degrees. Instructed on daily pin care
Week 7: Patient has good placement and progress
Week 8: External fixator removed in the OR. Exam under anesthesia (EUA) confirms that the affected area moves as a single unit and pins are removed
- Fluoroscopy after external fixation removal shows good alignment
- The patient is sent home with active range of motion as tolerated and a 5-pound lift restriction until approximately 12 weeks from initial surgery
Week 12: X-rays show good healing and the patient is advanced to no restrictions
Six Months: Images show good healing, the patient reports no pain and active forward flexion of 135°
Outcomes Achieved
- Good healing and alignment
- No signs of infection
- Good active range of motion; forward flexion 135°
- Patient reports no pain