Accuracy of the axillary projection to determine fracture angulation of the proximal humerus.

The accuracy of measuring angulation of stable proximal humerus fractures using the axillary lateral projection was investigated. A closing wedge osteotomy with apex anterior angulation was performed on two cadaveric humeri to simulate a stable surgical neck fracture. One specimen was fixed at 30 degrees angulation and the other at 55 degrees. Axillary radiographs were taken with each specimen articulating with the glenoid of a cadaveric scapula. The humerus was held in neutral rotation. Abduction was set at 30 degrees, 60 degrees, and 90 degrees. In each position of abduction, an axillary lateral radiograph was taken in 30 degrees forward flexion, neutral, and 30 degrees extension to simulate various arm positions. A total of nine radiographs were taken for each specimen. The axillary view is not accurate for measurement of proximal humerus angulation at the arm positions commonly encountered in the trauma setting.

Management of acute scaphoid fractures.

Scaphoid fractures are a common injury in young, active populations. Non-displaced fractures have a high union rate if promptly treated with cast immobilization. Displaced fractures and proximal pole fractures are best treated with operative fixation. There are a variety of techniques and implants available to the surgeon. The surgical approach and fixation device should be based on fracture characteristics and surgeon experience. Operative fixation of non-displaced fractures is an option in patients who would prefer to avoid prolonged cast immobilization.