Complex proximal umerus fracture

[luis pires]

29 years old women with car acidente
Profession: firemen
With com proximal umerus fracture (NeeR 4 part #) inicialy treated with K wires .
Comes to our Hopsital 4 month later
Function :
ABD 30º ADU 30º
Flex 40º EXT 30º
Ext ROT 0º Int ROT 30º
XR
TAC
RMN : avascular necrosis signal on umeral head, rotator cuff tear ( supra /infraespinh), intact subscapularis
What to do ?
Graft, correct angle,correct cuff and plate?
hemiartroplasty ?
Total shoulder Prosthesis ?



http://https://mail.google.com/mail/?hl=pt-pt&shva=1#inbox/12d525e3d07c2eb2

[Rajul Gupta]

my humble suggestion: dont attempt hemi/ total shoulder, its gonna be very tough seeing the quality of bone stock. Go for cuff repair first, and then see if there is any improvement