Subscapularis Peel for Open Reduction and Internal Fixation of Proximal Humerus Fractures With a Head Split.

Proximal humerus fractures involving an articular head split are rare and complex injuries. In the elderly population, arthroplasty is the optimal treatment, whereas in younger patients, the utility of arthroplasty procedures is limited by concerns of long-term implant survival. As a result, open reduction and internal fixation is still often the first-line treatment option for head-splitting injuries. The traditionally described deltopectoral or anterolateral surgical approaches to the proximal humerus rely on indirect reduction and limited visualization of the articular fragments. We present a case series of younger patients with head-split proximal humerus fractures treated with open reduction and internal fixation through a deltopectoral approach with a subscapularis peel to improve humeral head visualization, reduction, and fixation. The improved reduction may lead to better long-term outcomes and reduce the need for additional surgical procedures. In addition, there were no cases of avascular necrosis in this series.

Becoming the "captain of the ship" in the OR.

We have all been there: a screaming attending; an argument with anesthesia; a crashing patient, to name a few examples. A stressful situation in the operating room (OR) can unfortunately be a common occurrence. Many of these situations can be avoided if the team had been better prepared or had better communication. As the attending orthopaedic surgeon, YOU are the leader in the OR and the entire team looks at YOU for guidance and answers. Without your leadership, the ship will sink. Preparation, communication, and respect are essential elements that affect both patient outcomes and the atmosphere in the OR. In this article, we will highlight several pearls that will help you become and remain the best leader you can: the "Captain of the Ship."