OBJECTIVE: Rapid and effective reduction is difficult for minimally invasive plate osteosynthesis (MIPO) surgery. This study aims to introduce a bidirectional rapid reductor (BRR) designed to assist in the reduction during MIPO surgery for proximal humeral fractures (PHFs).
METHODS: This retrospective study was conducted between June 2021 and February 2022 in the Third Hospital of Hebei Medical University, involving patients diagnosed with PHFs. A detailed technical approach of BRR in MIPO surgery was described, and the patients\' outcomes based on postoperative radiographic results including x-ray postoperative follow-up, and clinical outcome parameters including visual analogue scale (VAS) and constant-Murley score at last follow-up were reported.
RESULTS: A total of 12 patients were included in this study, comprising three males and nine females, with an average age of 67.58 years. The mean operative time was 70.92 min (range 63-80 min). The mean blood loss was 102.27 mL (range 50-300 mL). The mean VAS and constant-Murley scores at final follow-up were 0.33 and 88, respectively. All patients had their fractures healed without secondary displacement at last follow-up. One patient experienced shoulder stiffness post-operation. There were no adverse events or complications following the use of this technique, such as acromion fracture, nerve or blood vessel injury.
CONCLUSIONS: The BRR can assist MIPO for good reduction of PHFs. However, the efficacy should be validated with a large-sample randomized controlled trial and longer follow-up.

BACKGROUND: Post-operative non-compliance is a risk factor for fracture fixation failure and presents a challenge for revision surgery planning. We present a patient who underwent revision surgery for a proximal humerus fracture with lateral locked plating augmented with a UV light activated intramedullary implant.
METHODS: A 45-year-old woman with a history of alcoholism presented with a proximal humerus fracture. After undergoing open reduction internal fixation with a lateral locking plate, the patient suffered a fall secondary to delirium tremens. New radiographs demonstrated displacement of the fracture with failure of screws. Revision surgery consisting of removal of the initial construct as well as open reduction internal fixation via lateral locking plate, augmented with a UV-activated intramedullary cement implant, was performed.
CONCLUSIONS: This is the first case report describing the use of a UV-activated intramedullary cement implant to augment the use of lateral locked plating for proximal humerus fractures. This case illustrates the successful management using UV-activated intramedullary cement to augment fixation, specifically in a patient with risk factors and post-operative non-compliance that predispose to fixation failure.

METHODS: A 34-year-old man was a restrained passenger involved in a high-speed rollover motor vehicle crash. The patient sustained a type 5 AC joint separation, severely comminuted intra-articular glenoid fracture with extension to the coracoid process base, displaced open scapular body fracture, a posterior shoulder dislocation of the glenohumeral joint, and a 2-part proximal humerus fracture.
CONCLUSIONS: To our knowledge, this is the first report describing this injury pattern involving the superior shoulder suspensory complex with an associated open proximal humerus fracture-dislocation.

METHODS: A 71-year-old woman presented with post-traumatic arthritis 11 months after open reduction and internal fixation for a left proximal humerus fracture (PHF) dislocation. After revision to reverse total shoulder arthroplasty (rTSA), the patient\'s left upper extremity was found to be avascular. An emergent thrombectomy was performed with restoration of arterial flow after removal of an acute-on-chronic axillary artery thrombus.
CONCLUSIONS: Although rare, as rTSA becomes more common for management of PHF, incidence of associated vascular injuries is likely to rise. Screening methods and clinical vigilance in diagnosis are advised for patients with anterior PHF dislocations and arterial injury risk factors.

Symptomatic varus malunion after proximal humeral fractures is associated with weakness and painful limitation of shoulder range of motion. When there is conformity of the articular surface and no avascular necrosis, a head-preserving procedure is best indicated. Arthroscopic arthrolysis, subacromial decompression, and tuberoplasty have been described for the treatment of mild deformity. In cases with more severe deformity, corrective extracapsular lateral closing wedge valgus osteotomy has been reported as a reliable treatment option, in terms of both pain relief and improved function. While this procedure adequately restores rotator cuff tensioning, it is associated with a shortening of the lever arm to the deltoid muscle, secondary to a loss of humeral length. We describe our technique and results with a vascular-sparing, medial open-wedge osteotomy, using a structural allograft and lateral locking plate. In our opinion, this procedure is safe and effective, with the potential to improve functional outcomes in young and active patients.

Two-and-a-half-month-old boy, a known case of brachial plexus birth injury, sustained proximal humeral diaphyseal fracture. Fracture healed in varus malunion and failed to remodel subsequently. Challenges were faced in the course of the management because of progression of the deformity. Finally, the fracture united after rigid internal fixation performed at 2.5 years.
Neuromuscular imbalance can lead to angular deformity at fracture site and cause unpredictable remodeling, as in our case. Conservative management may fail to achieve union with satisfactory alignment. Rigid internal fixation should be considered in such cases to achieve union.

A 16-year-old right-hand dominant male baseball player presented with little league shoulder in the setting of recombinant growth hormone utilization for growth hormone deficiency. After a prolonged treatment course, including physical therapy and throwing programs, the patient returned to baseball but suffered an ipsilateral proximal humerus fracture around the growth plate.
The occurrence of such an injury in the context of human growth hormone treatment merits consideration in youth athletes undergoing similar treatment regimens. Clinically, we recommend screening pediatric patients with sports-related epiphysiolysis for current or previous growth hormone use because of the possible prognostic implications of such treatment.

BACKGROUND: To investigate the clinical efficacy of the axillary approach in the surgical treatment of Ideberg type I and II scapular glenoid fractures.
METHODS: Retrospective analysis of 13 cases of scapular glenoid fracture treated in the affiliated Hospital of Jining Medical College, Jiaxiang County People hospital, Zoucheng City people Hospital, Yanzhou District People Hospital, and Juancheng County people Hospital from December 2020 to January 2022. Eight males (including 1 bilateral) and 5 females, with an average age of 57.5 years (range from 33 to 75 years). According to Ideberg classification, there were 10 cases of type I a, 1 case of type I a combined with type I b, and 2 cases of type II. All patients were treated with axillary approach surgery and 7 patients with combined anterior shoulder dislocation were treated by first-stage manipulation and second-stage reoperation. Seven patients were fixed with a wire anchor, 3 patients with type I a were fixed with a \"T\" plate, and 5 patients were complicated with rotator cuff tear and were repaired with a wire anchor. At the last follow-up, the Constant-Murley shoulder function score, visual analog score, DASH score, and Hawkins grade were used to evaluate shoulder function, pain, and stability after treatment.
METHODS: The intervention was to treat patients with Ideberg type I and II scaphoid fractures using an axillary approach.
RESULTS: All 13 patients in this group were followed up thoroughly, and the follow-up time was 12 to 25 months, with an average of 18.6 months. The operation time was 65 to 135 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 to 120 mL, averaging 55.6 mL. The duration of hospitalization ranged from 7 to 22 days, with an average of 9.6 days. The surgical incisions of all patients were grade-A healing. Bone healing of glenoid fractures was observed 3 months after the operation.
CONCLUSIONS: The axillary approach for Ideberg type I and II scapular glenoid fractures is a feasible surgical approach with complete access through the muscle gap, minimal surgical trauma, mild postoperative pain, and satisfactory clinical results.

METHODS: A 5-year-old previously healthy girl sustained a left proximal humerus fracture after a fall from a trampoline. The injury was initially treated nonoperatively, but during routine follow-up, the patient was found to have a previously unrecognized bony erosion at the fracture site. Workup was negative for neoplasm but instead demonstrated Salmonella osteomyelitis. The patient underwent debridement and treatment with antibiotics.
CONCLUSIONS: This is an unusual presentation of a humerus fracture in a child with concomitant Salmonella osteomyelitis. Osteomyelitis is an important diagnostic consideration when considering bony erosions in the pediatric patient, even in those patients without apparent risk factors.

The paper presents the results of stabilization of an unstable, comminuted fracture of the greater tubercle with absorbable sutures after fixation of a comminuted fracture of the proximal humerus with a reconstructive nail. This unusual procedure was performed upon ascertaining an anatomical reconstruction of the humeral head fragments and mechanical efficiency of the intramedullary nail fixation.Stabilization was performed with absorbable sutures through an extended surgical approach that allowed anchoring the unstable fragments of the greater tubercle to the shaft. The resulting anatomical positioning was additionally reinforced with screws locking the nail in its proximal end. After the procedure, a Dessault orthosis was used for 3 weeks, with intensive rehabilitation afterwards. A final assessment was made one year after the injury. It was based on the patients subjective feelings, the quality of bone union and fragment repositioning, estimated range of motion and limb function with Constant-Murley and QuickDash scores.An excellent treatment result was obtained. The anatomical position and shoulder function was fully restored. The patient reported no pain and no limb dysfunction.Based on these results we concluded that an open reduction and suturing of the unstable bone fragments of the greater tubercle with absorbable sutures allows anatomical repositioning and sufficient stabilization after intramedullary nailing. It may serve as an alternative to the conversion from intramedullary nailing to plate fixation in cases similar to ours.