Unlabelled: The authors report a case of an elderly female with a displaced varus misalignment of a proximal humerus fracture which met the indications for surgery, but the patient was treated conservatively with an arm sling due to the wishes of the patient and her relatives. The clinical outcome was nearly full function compared with the right shoulder.
Presentation Of Case: A 65-year-old Thai female presented with right shoulder pain 1 h after a fall during which her right shoulder hit the floor. Radiographs of the right shoulder in anteroposterior and lateral transcapular views showed a proximal humerus fracture with varus misalignment. The patient and her relatives decided on conservative treatment with an arm sling. At 12 weeks following the fall she was able to move her right shoulder nearly equally to the left shoulder.
Intervention And Outcome: The authors discussed the treatment options with the patient and her relatives and recommended open reduction and internal fixation with a locking plate and screw, but they decided on conservative treatment with an arm sling. At 12 weeks following the fall she was able to move her right shoulder nearly equally to the left shoulder. She had no pain and could do normal life activities with the right shoulder.
Relevance And Impact: Patients with severe varus deformity are usually treated with surgery. If there are contraindications for surgery, the stability of the fracture should first be evaluated through radiographs of the fracture in various arm positions.
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http://dx.doi.org/10.1097/MS9.0000000000000527 | DOI Listing |
Eur J Orthop Surg Traumatol
December 2024
Department of Orthopaedic Surgery, Royal North Shore Hospital, St Leonards, Australia.
Background: Proximal humerus fractures (PHF) are common with approximately 30% requiring surgical intervention. This ranges from open reduction internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population.
View Article and Find Full Text PDFJ Imaging
December 2024
Department of Orthopedic Research, Arthrex, 81249 Munich, Germany.
Objective: This study evaluated the effect of three-dimensional (3D) volumetric humeral canal fill ratios (VFR) of reverse shoulder arthroplasty (RSA) short and standard stems on biomechanical stability and bone deformations in the proximal humerus.
Methods: Forty cadaveric shoulder specimens were analyzed in a clinical computed tomography (CT) scanner allowing for segmentation of the humeral canal to calculate volumetric measures which were verified postoperatively with plain radiographs. Virtual implant positioning allowed for group assignment (VFR < 0.
Cureus
November 2024
Surgery, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, MEX.
Shoulder injuries, specifically proximal humeral fractures, are uncommon in skeletally immature patients. The anatomic characteristics of the humerus are determined by its ossification development, which is quite particular in the proximal segment where four principal segments have been outlined as fracture components in adults. Hereby, we present the case of an 18-year-old female who suffered a traffic accident that elicited a proximal humeral injury through the physeal line of the anatomical neck, as well as the treatment given and her clinical outcome with an effort to highlight the complexity of the diagnosis and management of this injury given the transitional bone age.
View Article and Find Full Text PDFBMC Musculoskelet Disord
December 2024
Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Jinshan Branch, Jinshan District Central Hospital, Shanghai, 201500, China.
Background: The lateral locking plate for the proximal humerus is currently the most commonly used surgical procedure for the treatment of elderly proximal humeral comminuted fractures. Previous studies have found that the rate of postoperative complications in patients of proximal humerus fractures with medial column involvement is relatively high. Through biomechanical methods, this study aims to investigate the effectiveness of the conventional lateral locking plate fixation along with the addition of the metacarpal supporting plate on the medial column in the treatment for proximal humeral fractures involving the medial column.
View Article and Find Full Text PDFJ Shoulder Elbow Surg
December 2024
Barnet and Chase Farm Hospitals, Royal Free London NHS Foundation Trust, London, UK.
Background: The optimal treatment of 3- and 4-part proximal humeral fractures in older adults remains controversial. This aim of this study was compare patient reported outcomes following reverse shoulder arthroplasty (RSA) or non-operative management in patients over 60 years old.
Methods: A retrospective review was undertaken of patients following 3- or 4-part proximal humeral fractures treated with RSA or non-operative treatment with minimum 2-year follow-up.
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