Rationale for Patient Selection
- 54-year-old, right-hand-dominant female with left displaced 2-part fracture due to fall down stairs
- Uncontrolled diabetic with HGB-A1c of 9.6 with higher risk of deep infection
- Initially treated with a shoulder immobilizer rather than surgical reduction and fixation due to risk of infection
- At 2 week follow up, patient given the option to continue with nonoperative care vs surgery. She elected to have surgery due to displacement and pain. NBX was applied as a lower risk option than open reduction and internal fixation
Assessment of Injury
- The greater tuberosity was not involved
- Week 2 Post-Injury: Patient returns for x-ray follow up. Elects for surgery
- While pin tract infection is a risk with external fixation, it was determined that the risk for deep infection was lower using this method as opposed to open reduction and internal fixation
External Fixator Placement
- Total operative time for placement: 33 minutes
- Day 18 Post-Injury: External fixator was applied. Images show good superior and inferior spread in the humeral head and good spread anterior to posterior
Post-Op Progress
Week 7: Images show good placement and progress toward healing
Six Months: Patient reports no pain, and the exam demonstrates very good active range of motion with forward flexion at 140°, external rotation at 35° and internal rotation to the upper lumbar area
Outcomes Achieved
- Good healing and alignment despite slight delay in initial surgical treatment
- No signs of infection
- The patient reports no pain
- Very good active range of motion
- Forward flexion 140°
- External rotation 35°
- Internal rotation to upper lumbar