Surgical Discussion

Patient positioning:  The patient was positioned in a beach chair position to facilitate the deltopectoral approach and optimize surgical access to the shoulder joint.

Anatomical surgical approach:  A deltopectoral approach was utilized, involving an incision along the deltopectoral groove. The cephalic vein was preserved, and the deltoid muscle was retracted laterally. Subperiosteal dissection was performed to expose the proximal humerus.

Intraoperatively, a humeral head osteotomy was performed to remove the fractured head. A glenosphere was placed on the glenoid, and a cemented humeral stem was inserted into the humeral canal. Osteosynthesis of the tuberosities was achieved using transosseous sutures combined with a graft from the excised humeral head.

Postoperative protocol:   The surgical team noted that the medialization of the diaphysis required careful handling during the procedure to ensure proper alignment and fixation of the tuberosities. The use of transosseous sutures provided stable fixation, and the humeral head graft facilitated healing.

Follow up:   Postoperatively, the patient followed a rehabilitation protocol involving immobilization in a sling for four weeks, with passive range of motion exercises initiated after two weeks. Active-assisted exercises were introduced at six weeks, progressing to active range of motion and strengthening exercises by three months post-surgery.

Orthopaedic implants used:   Not specified.