PROXIMAL HUMERUS FRACTURE:Orthopedic MD Oral Examination
1. Describe these radiographs.
2. How would you manage this isolated injury in this patient?
3. What surgery would you recommend and what would you tell the patient?
Proximal Humerus Fracture
These are AP and axillary lateral views of the proximal humerus. They show a displaced proximal humerus fracture.
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What surgery would you recommend and what would you tell the patient?
- I would plan to fix this fracture using a proximal humerus locking plate through a deltopectoral approach.
- I would tell the patient that surgery is generally safe and is likely to give him the best functional outcome and to avoid potentially painful mal- or non-union. There are risks inherent with any operation. Risks specific to this injury and operation include failure of fixation, neurovascular injury, shoulder stiffness, osteonecrosis and infection. These are rare and where avoided, the reported results are good. It is possible that for a patient with very low functional demands, non-operative treatment may allow healing with a functional result, but for a more active or physiologically younger patient, surgery does this more reliably although a multi-centre randomised trial (the PROFHER trial) did not find any difference in the outcomes of surgically and non-surgically treated patients after 2 years.