Complex proximal humerus fractures: Hertel's criteria reliability to predict head necrosis.

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Abstract

[Indexed for MEDLINE] 3. JBJS Essent Surg Tech. 2018 Oct 10;8(4):e26. doi: 10.2106/JBJS.ST.18.00003. eCollection 2018 Dec 26. Open Reduction and Internal Fixation with a Locking Plate Via Deltopectoral Approach for the Treatment of Three and Four-Part and Proximal Humeral Fractures. Thompson JH(1), Attum B(2), Rodriguez-Buitrago A(2), Yusi K(2), Cereijo C(2), Obremskey WT(2). Author information: (1)Hughston Clinic Trauma Services, Columbus, Georgia. (2)Vanderbilt Orthopaedic Trauma, Vanderbilt University Medical Center, Nashville, Tennessee. Open reduction and internal fixation (ORIF) via the deltopectoral approach is the gold standard for operatively treated proximal humeral fractures when joint preservation is desired. Indications include an unacceptable deformity, need for stability and early mobilization, and osteoporotic bone. (1) A 12 to 14-cm incision is made in the deltopectoral groove. The fracture is reduced. (2) Pins and tension sutures are placed for provisional fixation. (3) The locking plate is placed with unicortical screws in the metaphysis of the proximal part of the humerus and bicortical screws in the shaft. (4) The rotator cuff tendon is sutured into the open suture holes of the plate. (5) The surgical wound is then closed in a layered fashion. Hertel et al. reported that calcar length