Malunion of the humerus fracture can affect activities of living
About 2 months ago, an eighty years old women had a fall and landed on her shoulder. Her x ray showed her humerus was fractured near the shoulder joint. As her fracture was not suitable for surgical fixation because of osteoporosis, she was advised to rest her shoulder with conservative treatment. When she was followed up 6 weeks later, the fracture was healed and yet there was persistent shoulder pain and her daily activities was much affected. Review of her x ray showed that the fracture was very comminuted and its healing was not satisfactory. Her shoulder movement was limited and painful. She might need a shoulder arthroplasty in order to improve her upper limb function.
The clinical diagnosis of proximal humeral fracture can be graded according to number of fracture fragments: 2-part; 3-part and 4-part and above.
Clinically, 2-part and 3-part fractures are more common and can be surgically reduced and fixed with metallic plates and screws to promote healing. However, for patients with very osteoporotic bone, the metallic implant might not be able to hold the bone fragments well to achieve stable fixation.
With the introduction of titanium plates, locking screws and other innovative fracture fixation implants, treatment of osteoporotic fracture is much improved, supporting better surgical outcome.
For the 4-part and comminuted fracture of the proximal humerus, reduction and fixation is difficult and the recovery of shoulder function is not predictable. Shoulder arthroplasty is an option. Although the longevity of the arthroplasty is limited and might revision some years later, it will support useful shoulder movements and minimize the disability from the proximal humeral fracture.
Dr. KO, But-shui