这种好多我都用骨水泥棒固定了，因为患者换不起反肩，看一看西方的观点：Most proximal humerus fractures in elderly can be treated non-operatively. But this a clear cut case that needs surgery. Reserve shoulder arthroplasty is a game changer for these injuries.I fix the GT to get good deltoid wrap around effect. If there’s a lesser tuberosity fragment I keep the subscapularis attached to it, and fix the fragment to get better anterior stability. I excise the supraspinatus to prevent GT displacement superiorly, but keep the posterior rotator cuff.A lot of surgeons keep patients in a sling for 4-6 weeks. I let them move early. My post-op protocol is sling for 2 weeks, then start range of motion. Strength can begin at 6 weeks.
