Surgical Discussion

Patient positioning:  Supine position with the affected arm abducted and externally rotated on a radiolucent table to facilitate surgical access to the shoulder and axillary region.

Anatomical surgical approach:  An extended deltopectoral approach was utilized, involving an incision from the coracoid process extending distally along the deltopectoral groove. The cephalic vein was retracted laterally, and subdeltoid dissection was performed to expose the proximal humerus and axillary neurovascular structures. Fasciotomies were performed in all compartments to address potential compartment syndrome.

Significant intraoperative blood loss was encountered, estimated at 5 liters. Despite vascular surgery presence, extensive transfusion was required, including 8 units of packed red blood cells, 8 units of fresh frozen plasma, 1 six-pack of platelets, and 12 liters of crystalloid solution. The humeral head was extracted to allow for axillary artery repair and ligation of venous injuries. ORIF of the proximal humerus fracture was completed using appropriate fixation devices.

Postoperative protocol:   Postoperative rehabilitation included immobilization in a shoulder immobilizer initially, with gradual passive range of motion exercises introduced at 2 weeks post-surgery. Active-assisted range of motion exercises were initiated at 6 weeks, progressing to strengthening exercises by 12 weeks postoperatively.

Follow up:   Not specified.

Orthopaedic implants used:   Locking proximal humerus plate, vascular repair sutures, fasciotomy closure materials.