The Orthobullets Podcast Podiums | Trauma | Trauma Around the Shoulder: Seek and Destroy
Nov 30, 2025
Ray Penzi, a shoulder trauma expert, and Anand (Jack) Zandian, a renowned orthopaedic trauma specialist, delve deep into shoulder fracture management. They debate when to choose fixation over arthroplasty and share critical insights on protecting nerves and vascular structures during surgery. Technical pearls on tuberosity repair and tips for managing complex fractures are revealed, alongside discussions on setting expectations for rehabilitation. Their combined expertise offers a comprehensive look at optimizing shoulder trauma outcomes.
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Time And Patient Factors Dictate Fixation Versus Arthroplasty
- In acute displaced proximal humerus fracture-dislocations, attempt fixation in young reliable patients and act urgently rather than waiting a week.
- Consider arthroplasty for older, comorbid, or unreliable patients who cannot tolerate fixation attempts.
Secure Tuberosities For Arthroplasty Success
- For hemiarthroplasty, prioritize tuberosity repair with multiple heavy non-absorbable sutures and drill holes for fixation.
- Downsize the head and prepare for vascular/nerve issues when the humeral head is medialized.
Find And Protect The Plexus Before Manipulating The Head
- Medialized humeral heads risk axillary neurovascular injury and need plexus and vessel identification before aggressive manipulation.
- Consider coracoid osteotomy or soft-tissue release to safely expose and protect the neurovascular structures.