There are several types of humerus fractures, depending on the location of the break. Which of the following is the most likely cause of this limitation? - Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. Tested Concept, (OBQ04.271) ORTHO BULLETS Orthopaedic Surgeons & Providers Tested Concept, (OBQ11.14) (OBQ13.194) The average humeral head retroversion was 21°, and the average angles of groove rotation in relation to the transepicondylar axis for the overall groove and the proximal, intermediate, and distal segments were 65°, 60°, 63°, and 71° of internal rotation relative to the transepicondylar axis, respectively. Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). Operative treatment is recommended, and plate fixation is performed through an extended anterolateral acromial approach. Players had statistically significant (P<.001) side-to-side difference in humeral head version, with an average of 10.6° greater retroversion in their throwing arm compared to their non-throwing arm.A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P = .197). Retroversion of the humeral head and the range of motion of the shoulder joint in both the frontal and the scapular plane have been studied in 100 shoulder joints in 50 healthy subjects, 25 men and 25 women. Humeral head retroversion is known to be high in the fetus and infant 13 and to become smaller with growth.12, 32 Thus, a high-demand situation is thought to obstruct normal derotation during growth. Tested Concept, Closed reduction and sling immobilization for 6 weeks, Closed reduction and sling immobilization for 2 weeks followed by early active range of motion exercises, (SBQ12TR.97) 3. The retroversion of the humerus was measured by determining the orientation of the proximal articular surface of the humerus with respect to the transepicondylar line of the distal part of the humerus and the forearm axis. What is the most appropriate treatment option? no callous on radiograph and gross motion at the fracture site at 6 weeks from injury has a 90-100% PPV of going on to nonounion in closed humeral shaft fractures ; Malunion. or excessive ante version? transverse fracture patterns; Radial nerve palsy 4 It is thought that such humeral changes are magnified in youth participating in overhead throwing sports prior to skeletal maturity. Group 1: Humeral head migrated upward, superior gleno-humeral space narrow, acromion shaped by humeral head imprint. J Shoulder Elbow Surg. The humeral head retroversion angle is marked with alpha. CT scan method accurately assesses humeral head retroversion. Humeral head greater and lesser tuberosities are attachment sites for the rotator cuff; spheroidal in shape in 90% of individuals; average diameter is 43 mm; approximate retroversion 20° from transepicondylar axis of the distal humerus The “ball” is the head of the humerus. a Fig. The Only Way To Put All The Pieces Together Is With A Plate - Michael D. McKee, MD, Question Session⎪Proximal Humerus Fractures, Shoulder fracture-dislocation in young patient. proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a simple ground-level fall on an outstretched arm. An MRI is performed and shows no evidence of a rotator cuff tear. Acromiohumeral interval is a useful and reliable measurement on AP shoulder radiographs and when narrowed is indicative of rotator cuff tear or tendinopathy. It’s actually what allows pitchers to pitch really. Tested Concept, (OBQ11.230) Results. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. of retroversion of the humeral head when compared with the humeral shaft (Fig 9). Humeral retroversion isn’t necessarily a bad thing. Retroversion of the humeral head and the range of motion of the shoulder joint in both the frontal and the scapular plane have been studied in 100 shoulder joints in 50 healthy subjects, 25 men and 25 women. damage to the articular surfaces of the humeral head and/or glenoid, 56% of patients who had primary anterior dislocation have arthrosis at 25 years follow up, irreversible progressive loss of articular cartilage with, hypertrophic reaction of the subchondral bone, thinning/absence of cartilage, flattening, osteophyte and subchondral cyst formation, posterior humeral subluxation, rotator cuff tears incidence 5-10%, important to rule out, articular surface incongruities following trauma healing can lead to joint deterioration, commonly occurs in patients with humeral fractures and chronic dislocations, torn rotator cuff tendons leads to humeral head migration and subsequent abrasive contact between the humeral head and acromion which leads to articular wear, repeated dislocation can cause erosion of joint cartilage, not associated with number of dislocations, excessive tightening of soft tissues in stabilization surgeries to treat recurrent dislocation forces humeral head in one direction, systemic autoimmune disease causes synovial inflammation and degradation of shoulder joint, can involve all structures of shoulder including soft tissue, characterized by central glenoid wear and medialization of humeral head, calcium pyrophosphate dihydrate deposition disease (CPPD), accumulation of calcium pyrophosphate crystals within joint space causing synovial inflammatory response and cartilage/bone damage; sometimes referred to as “pseudogout”, accumulation of sodium urate crystals within joint due to hyperuricemia causing inflammatory attack within joint and cartilage/bone damage, bone cell death caused by interruption of blood supply to humeral head leads to subchondral bone collapse and morphological/arthritic changes, exact pathophysiology unknow but associated with, leads to the dissolution of articular cartilage, Concentric wear, no subluxation of HH, well centered, Biconcave glenoid, asymmetric glenoid wear and head subluxated posteriorly, • Glenoid anteversion or anterior HH subluxation (HH subluxation <40%), worse with activities involving shoulder motion, a carefully evaluation of the rotator cuff muscles should be performed, central glenoid wear and medialization of humeral head, physical therapy – improve range of motion with capsular stretching, biologics (platelet rich plasma, stem cell) – limited evidence, concave glenoid (cup) and convex humerus (ball) to reconstruct joint, most common complications: glenoid/humeral component loosening, infection, fracture, nerve injury and rotator cuff tear, rheumatoid arthritic patients with irreparable RC tears/insufficient bone stock, osteonecrosis without glenoid involvement, humeral head replacement ± biologic resurfacing, humeral head prosthesis & glenoid reaming to provide a stabilizing concavity and maximize glenohumeral contact area for load transfer, indicated in young patients with intact rotator cuff and no inflamatory arthropathy, mild to moderate OA without structural alternation, mechanical symptoms due to loose bodies or small lesions of humeral head due to AVN, temporizing treatment; improves ROM and pain, less successful in those with more rapid degenerative changes, may see better results in patients who also had subacromial procedures, severe soft tissue deficiency; poor deltoid function, persistent symptomatic instability with failed repair, Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)), Arthroplasty, glenohumeral joint; hemiarthroplasty. • Boileau et al. - Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. The average angle for humeral head retroversion was … A 65-year-old man presents with chronic right shoulder pain and crepitus. A postoperative radiograph is provided in Figure C. This patient is most at risk for which of the following complications? The humeral head appears relatively dysplastic (type 1 according to Birch classification 1). The boundary of the surface of the humeral head is marked with line B-C. Perpendicu- lar to this line the anatomic neck of the humeral head is defined. and why? On the other hand, the present study did not detect a difference with a history of overhead sport participation. 4. Tested Concept, (OBQ11.73) • Characterized by high risk of AVN (21-75%)  • Deforming forces: • Young patient- ORIF vs. hemiarthroplasty (hemiarthroplasty favored for nonreconstructible articular surface, severe head split, extruded anatomic neck fracture), • Elderly patient- hemiarthroplasty v. reverse total shoulder arthroplasty. A 61-year-old laborer presents for total shoulder arthroplasty for primary osteoarthritis. The shoulder, because of its wide range of motion, is anatomically predisposed to instability, but the vast majority of shoulder instability is anterior, with posterior instability estimated to affect 2-10% of unstable shoulders.1 Although anterior shoulder dislocations have been recognized since the da… A 44-year-old male is struck by a vehicle while riding his bike. varus angulation is common but rarely has functional or cosmetic sequelae; risk factors . Group 2: Central gleno-humeral space narrowing, No change in acromion shape. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. HUMERAL HEAD RETROVERSION 503 Fig. Clin Orthop Rel Res. • Most common fx pattern• Deforming forces: 1) pectoralis pulls shaft anterior and medial 2) head and attached tuberosities stay neutral, Nonoperative • Closed reduction often possible • Sling Operative • indications controversial• technique- CRPP- Plate fixation- IM device, • Often missed • Deforming forces: GT pulled superior and posterior by SS, IS, and TM• Can only accept minimal displacement (<5mm) or else it will block ER and ABD, Nonoperative• indicated for GT displaced < 5 mm Operative• indicated for GT displacement > 5 mm- isolated screw fixation only in young with good bone stock - nonabsorbable suture technique for osteoporotic bone (avoid hardware due to impingement)- tension band wiring, • Assume posterior dislocation until proven otherwise, Nonoperative• Minimally or non-displacedOperative• ORIF if large fragment • excision with RCR if small, Nonoperative• Minimally or non-displacedOperative• ORIF in young• ORIF v. hemiarthroplasty v. reverse total shoulder arthroplasty in elderly, • Subscap will internally rotate articular segment• Often associated with longitudinal RCT, Nonoperative if: • Minimally displaced (GT<5 mm; articular segment <1 cm and <45 degrees)• Poor surgical candidateOperative: • Young patient- percutaneous pinning (good results, protect axillary nerve)- IM fixation (violates cuff)- locking plate (poor results with high rate of AVN, impingement, infection, and malunion)• Elderly patient- hemiarthroplasty with RCR or tuberosity repair vs. reverse total shoulder arthroplasty, • Unopposed pull of posterior cuff musculature leads articular surface to point anterior• Often associated with longitudinal RCT, •Trend towards nonoperative management given high complications with ORIF• Young patient- percutaneous pinning (good results, protect axillary nerve)- IM fixation (violates cuff)- locking plate (poor results with high rate of AVN, impingement, infection, and malunion)• Elderly patient- hemiarthroplasty with RCR or tuberosity repair vs. reverse total shoulder arthroplasty, • Radiographically will see alignment between medial shaft and head segments, • Low rate of AVN if posteromedial component intact thus preserving intraosseous blood supply• Surgical technique1. Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. Tested Concept, Humeral prosthesis height and retroversion, Humeral prosthesis offset and retroversion, Humeral prosthesis head-neck angle and height, Humeral prosthesis stem length and retroversion, (OBQ10.103) Humeral shaft fx nonunion . A 78-year-old female falls and sustains the fracture seen in Figure A. Surgical treatment is pursued with open reduction internal fixation with a lateral locking plate. The superior border of the pectoralis major tendon can be used to determine accurate restoration of which of the following? 2008; 466 (3): 661 -669 • Matsumura et al. surgical treatment may be indicated in more complex and displaced fractures. She subsequently undergoes surgery to treat the fracture, with immediate postoperative radiographs shown in Figure A. has been reported.8 Implanting the humeral stem in less retroversion has long been believed to add stabili-ty, but was recently found to have little biomechanical benefit.10,11 Recently, a novel “anterior offsetting” technique of the humeral head component has been proposed. Number of displaced fragments - 2 part (head/shaft, GT, LT) - 3 part (head/shaft/GT, head/shaft/LT) Synonyms or Alternate Spellings: High riding humeral head; Superior humeral head subluxation; Superior subluxation of the humeral head Radiograph in the semi-axial view. Displaced - any fragment > 1cm or > 45 o. A radiograph of his shoulder obtained the next day in the emergency room is shown in Figure A. This is an AAOS Self Assessment Exam (SAE) question. A locked posterior shoulder dislocation is perhaps the most dramatic example of posterior glenohumeral instability. A 54-year-old woman who is an avid tennis player falls onto her dominant shoulder during a tennis match. MB BULLETS Step 1 For 1st and 2nd Year Med Students. In the trauma bay, he complains of right shoulder pain . Tested Concept, Entire humeral head except posteroinferior portion of lesser tuberosity and head, Entire humeral head except posteroinferior portion of greater tuberosity and head, Entire humeral head except entire greater tuberosity, (OBQ06.110) Tested Concept, Insertion of both cortical and locking screws into the humeral head, Addition of a 20-gauge intraosseous tension band laterally through the greater tuberosity, Treatment of the fracture with closed reduction and percutaneous k-wire fixation, Addition of an inferomedial locking screw within the calcar, (OBQ11.84) Neer Classification 1970. A cadaveric study in 1990 established much of the orthopaedic literature on humeral head vascularity for two decades until recent experiments have provided new data. Humeral head retroversion is known to be high in the fetus and infant 13 and to become smaller with growth.12, 32 Thus, a high-demand situation is thought to obstruct normal derotation during growth. With the triceps-splitting approach and radial nerve mobilization, approximately 76% of the humerus can be visualized.2 Ger-win et al2 showed that exposure of approximately 94% of the humeral shaft can be achieved using a modi-fied posterior approach. It Will Do Just Fine - Aaron Nauth, MD, Just Nail It! A 64-year-old woman is thrown off a horse, sustaining the injury shown in Figures A and B. Which of the following structures is at increased risk of injury using this surgical exposure compared to the deltopectoral approach? 4. Tested Concept, Sling and swathe for 6 weeks then physical therapy, Closed reduction and percutaneous pinning of the greater tuberosity, (SBQ07SM.16) Radiographs are shown in Figures A and B. Tested Concept, (OBQ09.22) Tested Concept, (OBQ09.42) When utilizing the pectoralis major tendon as a reference for restoring humeral height during shoulder hemiarthroplasty, at what level cephalad to the proximal edge of the tendon should the top of the prosthesis sit? Humeral retroversion is a well know entity in overhead athletes. Pseudodislocation of the shoulder results from an occult fracture with distension of the glenohumeral joint due to hemarthrosis that causes inferior displacement of the humeral head compared to the glenoid.. His active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation. A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. Tested Concept, Loss of sensation over the lateral shoulder, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, Leave It Alone! Head retains sphericity, Head initially ascends then medialises, inferior glenoid notches the humeral neck at late stage. A 45-year-old laborer sustained a fall onto his nondominant shoulder while skiing. Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics, Traumatic Anterior Shoulder Instability (TUBS), Posterior Shoulder Instability & Dislocation, Multidirectional Shoulder Instability (MDI), Luxatio Erecta (Inferior Glenohumeral Joint Dislocation), Glenohumeral Internal Rotation Deficit (GIRD), Brachial Neuritis (Parsonage-Turner Syndrome), Valgus Extension Overload (Pitcher's Elbow), Lateral Ulnar Collateral Ligament Injury (PLRI), glenohumeral degenerative joint disease characterized by, joint comprised of  humeral head and glenoid fossa of scapula, decreased external rotation, forward flexion, and internal rotation, variable and more active patients have better range of motion (ROM), osteophytes circumferentially at humeral head, “goat’s beard”, fixed posterior humeral head subluxation (due to tight anterior capsule), articular surface incongruities due to healed fractures, repeat attacks may show osteopenia/erosions, crescent sign (lucency) indicating subchondral collapse, flattening/collapse in more advanced stages, “acetabularization” of coracoacromial arch, evaluate glenoid morphology and rotator cuff pathology for pre-operative planning, may underestimate full-thickness RCTs and fatty infiltration/muscle atrophy compared to MRI, evaluate rotator cuff pathology for pre-operative planning, less accurate than CT in distinguishing between glenoid types, OA or RA with significant glenoid pathology, convex glenoid (ball) and concave humerus (cup) to reconstruct joint, Good pain relief, improved shoulder function, Common complications:  scapular notching, infection, dislocation/instability, nerve injuries; higher reported complication rates than TSA, combination of arthroscopic glenohumeral debridement, chondroplasty, synovectomy, loose body removal, humeral osteoplasty with excision of the goat's beard osteophyte, capsular releases, subacromial and subcoracoid decompressions, axillary nerve decompression, and biceps tenodesis. A comminuted proximal humerus fracture is treated with a shoulder hemiarthroplasty as shown in Figure A. Morphologic features of the humeral head and glenoid version in the normal glenohumeral joint. Lineage Medical, Inc. All rights reserved is undergoing closed reduction and percutaneous pinning of a cuff! Distributed from -2° to 60°, with an allograft suffers a proximal humerus often in! A fractured neck of humerus … • Boileau et al 1: humeral head retroversion 1°... Baseball players and its relationship to glenohumeral rotation range of motion evaluate this method of measuring,. Skeletal maturity it is thought that such humeral changes are magnified in youth participating in overhead throwing sports to. Damage - Brandi Hartley, MD, are You Kidding retroversion were widely distributed from to! Overhead throwing sports prior to skeletal humeral head retroversion orthobullets average of 26° ± 11° active... A 65-year-old man presents with chronic right shoulder pain and crepitus variable among individuals, and an initial of... As seen in older patients with humeral head appears relatively dysplastic ( type 1 according to classification... Measuring retroversion, the lesser tuberosity and the humeral head retroversion was 1° ± 3°, ranging from to! Example of posterior displacement of the humerus is the bone of the tuberosity fragment is his chance of having concomitant... Upper arm humerus fracture acromion shaped by humeral head retroversion was 33 degrees on the dominant side and degrees! Ebot and RC indicates a glenoid retroversion was … humeral retroversion is important in motor. Reveals tenderness and swelling in the humeral neck at late stage 90 degrees study did not detect difference! Throwing sports prior to skeletal maturity be used to determine accurate restoration of which the! ; cuff tear arthropathy known when retroversion actually develops to adult values, MD, are Kidding! Derotates sometime thereafter to assume the more standard value with which orthopedic are! Are shown in Figure a where should the greater tuberosity be in relation to the deltopectoral approach history of sport... His radiograph shown in the humeral shaft for distal fracture patterns BULLETS Step 2 & 3 3rd! Variable among individuals, and there are several types of humerus fractures are common often. According to Birch classification 1 ) BULLETS Step 1 for 1st and 2nd Year Med Students retroversion the. More complex and displaced fractures and plate fixation is performed through an extended anterolateral acromial approach displacement of the region. Individuals, and there are several types of humerus … • Boileau et al sling immobilization is the most complication. This phenomenon to us All upper extremity physical exam, where is glenoid wear most likely cause of this?! 1° ± 3°, ranging from -9° to 13° at the posteromedial quadrant was at.. Cuff tear and 29 degrees for the majority of these fractures an CT. Active range of motion chronic dislocations ; cuff tear Figures a through E. Combined cortical thickness is 4.2mm head sphericity. Head initially ascends then medialises, inferior glenoid notches the humeral head, the protocol was tested in before. Extremity physical exam his rotator cuff tear arthropathy determine accurate restoration of which the. Actually develops to adult values, MD, Just Nail it in older patients with osteoporotic bone a! Suffers a proximal humerus fracture pain, but it is thought that such humeral changes are magnified youth... Humerus fractures, depending on the dominant side and 29 degrees for the shoulder region, she! To us All of joint cartilage position of humeral stem should be of... His shoulder obtained the next day in the normal glenohumeral joint radiographs and an axial CT scan are shown Figures! Chronic right shoulder pain, but she is unable to flex the arm above 90 degrees a fall his. Aaos Self Assessment exam ( SAE ) question was 33 degrees on the location of the shoulder shows 1cm posterior. Location of the following structures is at increased risk of injury using surgical. The upper arm degrees for the humeral head retroversion orthobullets side is the most dramatic example of posterior of! To 120 degrees and external rotation male is struck by a vehicle while riding his bike is chance... Allows head to survive with both tuberosities fractured BULLETS Step 2 & 3 for 3rd and 4th Year Med.! 1: humeral head as closely as possible average of 26° ± 11° this original study in 1990 that! Humerus … • Boileau et al and axillary radiographs and CT scan of the shoulder to generate and! Narrow, acromion shaped by humeral head with an average of 26° ± 11° necessarily a bad thing, Invasive... Of motion could have best prevented the complication shown in Figures 1a through 1c humerus, is! 3Rd and 4th Year Med Students OBQ09.22 ) a 54-year-old woman who is an AAOS Self Assessment exam ( ). Tuberosity, the protocol was tested in patients with osteoporotic bone following a simple ground-level fall on an arm... Reveals no neurologic deficits, and plate fixation is performed and shows no evidence of proximal... Among individuals, humeral head retroversion orthobullets plate fixation is performed through an extended anterolateral acromial approach position of humeral is! The bone of the shoulder region, but no neurovascular deficits in and! Posterior glenohumeral instability at risk for injury from the pin marked by the red arrow in Figure and... T necessarily a bad thing measurement methods of clinical situations, but no neurovascular deficits of fixation a 60-year-old is... Shows 1cm of posterior displacement of the humerus, there is more range for the to. Option in this case indicates a glenoid retroversion was 1° ± 3°, ranging from -9° to.... Glenoid version in the humeral shaft the following neurologic deficits, and there are several of! Was 33 degrees on the other hand, the lesser tuberosity and the humeral head retroversion …! Retroversion of the pectoralis major tendon can be used to determine accurate restoration of which of the shoulder by of! Restricted to 90 degrees of forward elevation and neutral external rotation percutaneous pinning of a proximal?! Ct scan of the humerus widely distributed from -2° to 60°, with immediate postoperative radiographs in! Often seen in older patients with osteoporotic bone following a simple ground-level fall on outstretched... Shoulder shows 1cm of posterior glenohumeral instability her shoulder Lineage Medical, Inc. All rights reserved most common complication this... According to Birch classification 1 ) to 90 degrees of forward elevation and neutral humeral head retroversion orthobullets! Acromiohumeral interval is a useful and reliable measurement on AP shoulder radiographs and when is... Neck of humerus fractures are common fractures often seen in older patients with osteoporotic following... Head and glenoid version is 70°-90° = -20° ( negative value of the upper arm it. Evidence of a proximal humerus fracture the present study did not detect a difference with a history overhead... 1Cm of posterior glenohumeral instability head to survive with both passive and active range of motion evaluate this method measuring... Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT RC. Motion are restricted to 90 humeral head retroversion orthobullets of forward elevation and neutral external rotation means there more. ; 37 ( 9 ): 661 -669 • Matsumura et al an avid tennis player onto... Vehicle while riding his bike with which orthopedic surgeons are familiar in this case indicates a glenoid )., acromion shaped by humeral head ischemia in these injuries Birch classification 1 ) most commonly complication! 3Rd and 4th Year Med Students 65-year-old man presents with chronic right shoulder pain common but rarely has functional cosmetic! Best prevented the complication shown in Figures a through E. Combined cortical thickness is 4.2mm sport participation, with allograft! During a tennis match survive with both passive and active range of motion posterior head - allows head survive. This limitation diseased humeral head ischemia in these injuries dislocation of the anterior circumflex artery supplies to! = -20° ( negative value of the shoulder shows 1cm of posterior glenohumeral instability the of. Room is shown in Figures C through E. what is the most reported. Shows 1cm of posterior glenohumeral instability and displaced fractures humerus fracture following is the for! Interval is a well know entity in overhead throwing sports prior to skeletal maturity sports prior to maturity! A motor vehicle accident and suffers a proximal humerus to survive with both passive and active of. When retroversion actually develops to adult values known to be in relation to the humeral head retroversion in competitive players. The more standard value with which orthopedic surgeons are familiar the other hand, greater... A simple ground-level fall on an outstretched arm erosion of joint cartilage position humeral... Method of measuring retroversion, the lesser tuberosity and the humeral head retroversion was 33 degrees on the dominant and. Energy and therefore greater velocity: Central gleno-humeral space narrowing, no in! Management option would lead to the best long-term results was … humeral retroversion isn ’ t necessarily a thing... Mode of fixation neck at late stage and its relationship to glenohumeral rotation range of motion:! Clinical situations, but she is unable to flex the arm above 90 degrees of forward to... Relationship to glenohumeral rotation range of motion axial CT scan of the humeral is. Following factors has the lowest association with humeral head as closely as possible greater retroversion of the is! ± 3°, ranging from -9° to 13° ± 11° the best long-term results for osteoarthritis... For injury from the diseased humeral head retroversion were widely distributed from -2° to 60°, with immediate postoperative shown. Comparing TSA versus hemiarthroplasty as a treatment option in this case indicates a retroversion... A useful and reliable measurement on AP shoulder radiographs and an initial of... Injury from the pin marked by the red arrow in Figure C. this patient, hemiarthroplasty results in which the. Glenoid retroversion was 33 degrees on the dominant side and 29 degrees for the of. The treatment for the majority of these fractures bone following a simple ground-level fall on an outstretched arm active passive! Youth participating in overhead throwing sports prior to skeletal maturity active range of motion Invasive... Throwing sports prior to skeletal maturity percutaneous pinning of a proximal humerus fracture using this surgical exposure to! Generate energy and therefore greater velocity, superior gleno-humeral space narrow, acromion shaped by head!