Surgical Discussion

Patient positioning:  The patient was positioned in a lateral decubitus position to facilitate access to the posterior aspect of the humerus.

Anatomical surgical approach:  A modified Gerwin approach was utilized, which is a triceps-sparing technique. The triceps was elevated laterally until limited by the lateral head. Careful protection of the radial nerve and its branches was ensured. The interval between the long and lateral head of the triceps was developed to access the proximal humeral shaft. Retraction of the deltoid and axillary nerve allowed access up to the neck if necessary.

The surgeon opted for a long lateral column plate to eliminate the possibility of stress risers, considering the patient's history and potential for future falls. Although a medial column plate was not used, it was noted that it could provide additional stability against varus failure, especially in more complex fracture patterns.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with range of motion exercises as tolerated, avoiding weight-bearing activities on the affected limb for an initial period, followed by gradual strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Long lateral column plate, 2.4mm lag screws.