Multiple approaches were used to address this fracture in a 60 y/o male, smoker, functional alcoholic patient with osteoporosis. Initially, nonoperative treatment was attempted, however, after two weeks, his displacement and pain levels had risen to the point that operative fixation was performed.
A direct lateral approach was made and identification of the axillary nerve achieved. The head segment of the humerus was controlled through the use of #2 Fiberwires in the supraspinatus and subscapularis. Then a modification of the parachute technique was utilized to create a valgus impacted pattern by crossing the fibers under the axillary nerve and affixing them with two 3.5 mm swivel-lock anchors.
Once preliminary fixation was achieved, implant purchase was enhanced by placing a 22/13x160 mm tapered IlluminOss implant in the canal, filling it with monomer and curing it with with blue light. After curing, the entire construct was spanned with a lateral based proximal humerus plate with all screws having improved purchase and decreased working length to prevent toggle and loosening.
Dynamic fluoro evaluation noted solid movement. So, while weight bearing was restricted, the patient was allowed immediate active and passive motion.