Proximal Humerus / Shoulder Flashcards
Humeral head blood flow
ascending branch of anterior humeral circumflex artery and arcuate artery
provides blood supply to humeral head
vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove
beware not to injure when plating proximal humerus fractures
arcuate artery is the interosseous continuation of ascending branch of anterior humeral circumflex artery and penetrates the bone of the humeral head
posterior humeral circumflex artery
most current literature supports this as providing the main blood supply to humeral head
causes of AVN
Remember ASEPTIC mneumonic
Alcohol, AIDS
Steroids (most common), Sickle, SLE
Erlenmeyer flask (Gaucher’s)
Pancreatitis
Trauma
Idiopathic/ Infection
Caisson’s (the bends)
may be atraumatic
posttraumatic
four-part fracture-dislocations approach 100% AVN
displaced four-part fractures ~45% AVN
valgus impacted four-part ~11% AVN
three-part ~14% AVN
Cruess Classification
Cruess Classification (stages)
Radiographic findings
Treatment
StageI
Normal x-ray, changes on MRI only
Core decompression
Stage II
Sclerosis (wedged, mottled) Osteopenia
Core decompression
Stage III
Crescent sign indicating a subchondral fracture
Resurfacing or hemiarthroplasty
Stage IV
Flattening and collapse
Resurfacing or hemiarthroplasty
Stage V
Degenerative changes extend to glenoid
Total shoulder arthroplasty
location of AVN starts at
superior middle portion of humeral head
what does crescent sign indicated
subchondral collapse
Nonop treatment for AVN
pain meds, activity modification, physical therapy
anotehr mnemonic for AVN causes
PLASTIC RAGS
P: pancreatitis, pregnancy
L: lupus (SLE)
A: alcohol excess (chronic)
S: steroids
T: trauma
I: idiopathic, infection
C: caisson disease, collagen vascular disease
R: radiation, rheumatoid arthritis
A: amyloid arthropathy
G: Gaucher disease
S: sickle cell disease
