If the fracture is displaced but only in 2 parts, a closed reduction and percutaneous pinning may be an option. The other option includes open reduction and internal fixation. This is also the best option when multiple parts (pieces) exist. Though this option involves a sizeable incision, the newest plates available are rigid enough to allow earlier range of motion. So our discussion will center around the feasibility of different operative options, what you would ideally prefer, and what may be most ideal given your circumstances--work, hobbies, health, size of arm, xray etc.
When a fracture is displaced and not fixable, a replacement of the humeral head (hemiarthroplasty)may be the best option. A successful functional outcome requires tuberosity union----for it is through this that the rotator cuff remains functional. Even so--although this procedure will take away the majority of your pain, it may only result in range of motion that allows the hand to get to your face and head, and not much higher. So, we try to avoid this option, but when little else is possible, it serves as a valuable choice.
The newest developments in Arthroplasty include "fracture-specific" humeral stems with "windows" that allow for the placement of bone graft, and lateral offset, both of which allow for better tuberosity reduction and healing, ideally. In addition, the Reverse design is often used in patients with these fractures who are older than 70 because of an improved functional outcome compared to hemiarthroplasty. In this subset of patients (older than 70) it is often more difficult to achieve tuberosity healing.
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mtomaino 3/6/11 at 12:04 pm
On March 3rd I had the privilege of fixing a displaced proximal humerus fracture that had originally appeared as "nondisplaced" (see video attached above ["Case example"]). However, it ultimately moved, in terms of position, and to restore the highest liklihood of bony healing and shoulder function, I performed an open reduction and internal fixation surgery using a Depuy S3 locking plate. This device provides stable fixation to allow early passive range of motion, while minimizing the risk of "impingement" once overhead motion is restored.
During the 1st 6 weeks after surgery a sling will be required, but we will typically allow pendulum exercises and gentle passive range of motin exercises.