Proximal Humerus [Case 07] - Head-Split in a Young Patient with Plate and Screws

This orthopedic trauma learning case presents the operative reasoning for a complex proximal humerus fracture with four-part morphology and head-split characteristics involving the glenohumeral joint surface. The case emphasizes the decision-making process behind attempting osteosynthesis rather than proceeding directly to arthroplasty, based on fracture personality and patient-specific considerations discussed in the operative narration.

The educational focus is on surgical exposure through the deltopectoral interval, identification of key anatomical landmarks, careful soft-tissue handling, and the use of high-strength sutures to control the rotator cuff and tuberosity fragments. The procedure demonstrates how the long head of the biceps, bicipital groove, subscapularis, supraspinatus, and infraspinatus can be used as orientation and manipulation references during reduction.

A major teaching point is the creation of a functional proximal fragment block by linking the greater and lesser tuberosities with sutures, allowing the surgeon to manipulate the proximal humeral segment more predictably during reduction. The case also discusses challenges created by varus impaction, limited visualization, retractors, and the need to balance exposure with preservation of reduction mechanics.

This content is intended for medical and surgical education only. It does not provide individualized medical advice, does not replace formal surgical training, and does not guarantee any clinical outcome. All procedural decisions must be made by qualified healthcare professionals using appropriate clinical judgment, institutional protocols, imaging review, and patient-specific evaluation. Human expert review is required before educational or clinical use.