Proximal Humerus Fractures

ALAM ZEB

Learning Objectives

bullBony and Muscular anatomy of the proximal humerusbullEpidemiological factors and common mechanism of injury for proximal humeral fracturesbullDiagnostic toolsbullObjective ExaminationbullManagementbullRehabilitation program bullCommon complications

Bony Anatomy1048698 Humeral HeadShaft

1048698 Greater Tuberosity

1048698 Lesser Tuberosity

1048698 Surgical Neck

1048698 Anatomical Neck

Muscular Anatomy

bull Subscapularis attaches to lesser tuberositybullSupraspinatusInfraspinatusTeres Minor attaches to greater tuberositybullDeltoid attaches to deltoid tuberositybullPectorolis Major attaches to lateral lip of bicipital groove

Epidemiologybull 4-5 of all fracturesbull 75 of humeral fractures in patients over 40bull Women incidence gt Men ndash osteoporotic factor

Mechanism of InjuryOver 50 ndash Minimal to moderate trauma ndash More typically indirect mechanism such as fall on an outstretched hand Under 50 ndash High-energy trauma ndash More typically direct impact or fall on the shoulder ndash May be concurrent with dislocation due to higher forces

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Learning Objectives

bullBony and Muscular anatomy of the proximal humerusbullEpidemiological factors and common mechanism of injury for proximal humeral fracturesbullDiagnostic toolsbullObjective ExaminationbullManagementbullRehabilitation program bullCommon complications

Bony Anatomy1048698 Humeral HeadShaft

1048698 Greater Tuberosity

1048698 Lesser Tuberosity

1048698 Surgical Neck

1048698 Anatomical Neck

Muscular Anatomy

bull Subscapularis attaches to lesser tuberositybullSupraspinatusInfraspinatusTeres Minor attaches to greater tuberositybullDeltoid attaches to deltoid tuberositybullPectorolis Major attaches to lateral lip of bicipital groove

Epidemiologybull 4-5 of all fracturesbull 75 of humeral fractures in patients over 40bull Women incidence gt Men ndash osteoporotic factor

Mechanism of InjuryOver 50 ndash Minimal to moderate trauma ndash More typically indirect mechanism such as fall on an outstretched hand Under 50 ndash High-energy trauma ndash More typically direct impact or fall on the shoulder ndash May be concurrent with dislocation due to higher forces

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Bony Anatomy1048698 Humeral HeadShaft

1048698 Greater Tuberosity

1048698 Lesser Tuberosity

1048698 Surgical Neck

1048698 Anatomical Neck

Muscular Anatomy

bull Subscapularis attaches to lesser tuberositybullSupraspinatusInfraspinatusTeres Minor attaches to greater tuberositybullDeltoid attaches to deltoid tuberositybullPectorolis Major attaches to lateral lip of bicipital groove

Epidemiologybull 4-5 of all fracturesbull 75 of humeral fractures in patients over 40bull Women incidence gt Men ndash osteoporotic factor

Mechanism of InjuryOver 50 ndash Minimal to moderate trauma ndash More typically indirect mechanism such as fall on an outstretched hand Under 50 ndash High-energy trauma ndash More typically direct impact or fall on the shoulder ndash May be concurrent with dislocation due to higher forces

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Muscular Anatomy

bull Subscapularis attaches to lesser tuberositybullSupraspinatusInfraspinatusTeres Minor attaches to greater tuberositybullDeltoid attaches to deltoid tuberositybullPectorolis Major attaches to lateral lip of bicipital groove

Epidemiologybull 4-5 of all fracturesbull 75 of humeral fractures in patients over 40bull Women incidence gt Men ndash osteoporotic factor

Mechanism of InjuryOver 50 ndash Minimal to moderate trauma ndash More typically indirect mechanism such as fall on an outstretched hand Under 50 ndash High-energy trauma ndash More typically direct impact or fall on the shoulder ndash May be concurrent with dislocation due to higher forces

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Epidemiologybull 4-5 of all fracturesbull 75 of humeral fractures in patients over 40bull Women incidence gt Men ndash osteoporotic factor

Mechanism of InjuryOver 50 ndash Minimal to moderate trauma ndash More typically indirect mechanism such as fall on an outstretched hand Under 50 ndash High-energy trauma ndash More typically direct impact or fall on the shoulder ndash May be concurrent with dislocation due to higher forces

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Diagnostic Studies

X-ray (Trauma Series)ndash A-Pndash Lateral (Y-view)ndash Axillary View CT Scanndash To determine fracturealignment anddisplacement

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Objective Examination

bull Varies related to type of fracture and amount of displacementbull Painful motionbull Swelling and delayed ecchymosisbull Tenderness to palpationbull Crepitus indicative of fracture instabilitybull IRER to assess proximal and distal humerus move simultaneously as a unit

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

General Treatment OptionsNon-Operative

bull80 of PHF are NONDISPLACED and can be successfully treated NONOPERATIVELY

Operativebull20 of PHF are Displaced which can be treated operatively and non-operativelyit depends upon the fracture paterrnOperative Techniques used are - Percutaneous pinningndash Plates and screwsndash Intramedullary rodsndash Humeral head prosthesis

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Operative Techniques

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Rehabilitation Early and aggressive rehabilitation program designed to bullPrevent stiffness and restore nomal ROMbullMaintain normal relationship between head of Humerus and gleniod cavitybullProvide stability at Fracture sitebullRegain strength of shoulder musles

bull Rehabilitation exercise needs to begin within14 days of injury to increase likelihood ofacceptable outcome and reduce chance formotion complications

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Typical ProgressionIst weekbullAll shoulder movements are avoidedbullStrengthening exercises are avoidedbullWeight bearing is strictly prohibitedbullProvide assistance in daily life activities Weeks 2-4 bullPendulum exercises with sling are startedbullIsometric shoulder exercisesbullWeight bearing is prohibitedWeeks 4-8 bullPerform active active assisted and passive ROM to shoulder and elbowbullIsometric and Isotonic exercise

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Typical Progression

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

Common Complicationsbull Stiffnessbull Non-Union or Malunionbull Avascular Necrosisbull Neurovascular Injurybull Myositis Ossificans

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14

• Proximal Humerus Fractures
• Learning Objectives
• Bony Anatomy
• Muscular Anatomy
• Epidemiology
• Diagnostic Studies
• Objective Examination
• General Treatment Options
• Operative Techniques
• Rehabilitation
• Typical Progression
• Typical Progression (2)
• Common Complications
• Slide 14