Fracture of the proximal humerus is a common orthopaedic injury and is likely to increase in incidence. This fracture type is associated with a wide variety in fracture morphology and as a direct result there are many treatment options available. It is often not clear what treatment modality should be utilised. This article reviews the current literature on proximal humerus fractures offering evidence for care pathways and management strategies from presentation to rehabilitation.

Average volume-assured pressure support (AVAPS) is a novel way to deliver NIV. In this mode, a target tidal volume is set, and the device adjusts the pressure support to reach that volume. A particular potential benefit is that it may adapt to disease progression, as in patients with progressive Motor Neurone Disease. NICE guidance (2010) recommend follow up every 3 months. We propose to investigate if this new technology improves safety during the initial period of ventilator support.AimTo identify the trend in pressure support and hours of use of AVAPS ventilation in patients with ventilatory failure due to MND.Look at compliance and tolerability on patients with AVAPS.MethodsRetrospective review of case notes and downloads from the ventilators of 6 patients identified to have started on AVAPS due to ventilatory failure secondary to MND. Average AHI, IPAP, EPAP, hours of use, compliance during first three months were reviewed.ResultsThere was no significant change in IPAP (Mean 14.78 at 1 month, 14.98 at 3 months) or EPAP (5.91 at 1 month, 6.57 at 3 months). Average use (6 hrs 44 min at one month rising to 8 hrs 48 min at three months) and compliance (percent greater than 4 h 77.6% at 1 month to 89.5% at 3 months) did show positive trends but did not reach significance.Abstract P199 Table 1Summary of NIV usageMonth 1Month 3N66AHI6.984.8IPAP14.7814.98EPAP5.916.57Avg use06:4408:30Avg hrs when using06:4408:48% >4hrs77.689.5ConclusionsThis study shows an increase in average hours of use and compliance in the first 3 months of use. Tidal volumes and pressure support remain preserved. This initial data would suggest no benefit in providing the more expensive AVAPS machine compared to standard BiPAP S/T mode. Larger prospective studies looking at disease progression and ventilation usage in MND are warranted.

A 79-year-old man presented to the emergency department following a 1-week history of dyspnoea, dysphonia, dysphagia and a nonproductive cough. Previous medical history included atrial fibrillation, for which he was taking rivaroxaban, hypertension and obstructive sleep apnoea. On assessment, there was a mild stridor, swelling of the anterior aspect of the neck and submandibular bruising. CT of the neck demonstrated prevertebral soft tissue swelling extending from C1 to C6 levels, approximately 88 mm in length with a maximum depth of 25 mm. A diagnosis of spontaneous retropharyngeal haematoma was made: the airway was secured with fibreoptic nasal intubation and the patient admitted to the intensive care unit. Direct and fibreoptic assessment of the airway on day 3 confirmed that the haematoma had significantly reduced in size. The patient was extubated on day 4 and made a good recovery.