The surgical treatment of proximal humerus fractures, though common, is associated with surprisingly high complication rates upward of 34%. Obtaining a reduction and placing a stable fixation can be challenging because many fractures treated surgically are comminuted and occur in osteoporotic bone. Nevertheless, innovations in technique and implant design are mitigating some failures. These innovations include the use of fibular strut allograft and other fixation adjuncts, the correct placement of calcar screws and other locking fixation, and having a systematic approach to reduction and intraoperative imaging to ensure the restoration of anatomy. This review and accompanying video highlight various technical strategies to maximize the success of surgical treatment for these challenging injuries.

Using a case-control design, clean-catch urine samples were obtained from 170 subjects, 108 women (F) and 62 men (M). 16S Next-Generation Sequencing (NGS) was performed to identify Mycoplasma and Ureaplasma populations, with confirmatory quantitative PCR analyses quantitating the DNA levels for each species identified. The Genitourinary Pain Index (GUPI) (M&F) was used to characterize painful and voiding symptoms. All patients had negative urine bacterial cultures. Linear regression analysis was used to explore the associations between microbial content and symptomatology.RESULTS: Of 170 subjects, 61 F (56%) and 43 M (69%) had pain >3 on a Likert scale (0-10). By NGS, both relative abundance and overall prevalence of detectable Ureaplasma were greater in controls than symptomatic patients. By qPCR, U. parvum was present in 25% F and 5% M subjects, but only three patients displayed detectable U. urealyticum, all of whom were in the asymptomatic group. Ureaplasma concentrations, determined by qPCR, were negatively associated with all symptoms assessed: overall pain, urinary frequency, urethral pain, dysuria, and bother (Figure 1). Mycoplasma species were not present in adequate amounts to allow for analysis.CONCLUSIONS: Ureaplasma spp. are negatively associated with lower urinary tract symptoms, and unlikely to be a significant cause of genitourinary pain. Given a high prevalence in asymptomatic subjects, screening for atypical organisms will result in significant overtreatment, leading to unnecessary disruption of the genitourinary microbiome of these patients and increased risk of development of antimicrobial resistance.