PROXIMAL HUMERUS FRACTURE
An 80-year-old woman attends the fracture clinic after stumbling and hitting her shoulder Against a banister..
- Describe these radiographs.
These are AP and axillary lateral views of the proximal humerus. They show a minimally displaced proximal humerus fracture.
- How would you manage this patient?
- would make a careful clinical assessment of the patient and from the history and examination I would want to confirm that this is an isolated low-energy injury, the state of the soft tissues and any neurovascular deficit. I would make an assessment of the functional requirements of this patient. I would expect that this minimally displaced fracture pattern would be best treated non-operatively for this patient.
I would treat this patient in a collar and cuff and would follow-up with her in the fracture clinic. I would prescribe physiotherapy-supervised early active movement from the 3-week point post-injury.
- What indications would make you consider operative intervention?
would choose operative intervention for open fractures or where the skin is threatened or compromised, a vascular injury or a floating shoulder. Otherwise, surgery would be directed to obtain improved functional outcome. Fractures where surgery is likely to achieve this include head-splitting fractures, fractures with marked displacement which may predispose to mal- or non-union and especially where there is articular disruption