.-Three fragments non displaced proximal humerus fracture treatment options


Q: My father was recently in an accident which resulted in a Comminuted (3 - Part) Fracture of the Right Humeral Head (his main hand). The Shoulder has been immediately immobilized and there is no dislocation or displacement. He is 56 years of age and has Diabetes from the past 15 years. We consulted a couple of orthopedic doctors and we have 2 treatment options 1. Natural healing - shoulder is put in an immobilizer for the next 4 weeks and treated with pain killers. 2. Heumeral Nailing - a metal nail and a few pins hold the bone in place; minimally invasive While natural healing seems to be the least risky in terms of infection and non-invasive for a diabetic; The pinning procedure seems to be more effective in terms of pain management and seems to allow faster mobility of the shoulder, And my father does seem to be in pain for the slightest movement of the arm. So we are trying to gather as much information as possible before making a decision on either treatment option. Thank you for your time.


A:    When treating a patient with a proximal humerus fracture, the physician must consider many factors. The type of fracture, patient ability to participate in rehabilitation, general health and age of the patient, associated health problems and time from injury to treatment are important factors that affect treatment results. Additionally, surgical reconstruction of the proximal humerus may be technically difficult.The majority of fractures (about 85%) are nondisplaced, and nonoperative treatment with a sling and early range-of-motion (ROM) exercises is usually successful. Gentle Range Of Motion exercises may begin after 7-10 days if the fracture is stable. When fracture displacement occurs, operative intervention is selected. Surgery may be recommended if one or more of the fracture fragments is displaced or angulated. In general, 2- and 3-part fractures are treated with open reduction and internal fixation (a plate with screws is the choice of many surgeons currently). Four-part fractures in the younger, active patient also can be treated successfully with open reduction and internal fixation. However, in the elderly and in the patient with osteoporosis, a hemiarthroplasty (one joint surface is replaced with an artificial material, usually metal). is the treatment of choice. Contraindications for repair of proximal humerus fractures include inability to tolerate the procedure medically and lack of clearance for surgery through the primary care physician or specialty consultants (ie, cardiologist, vascular specialist).

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