Description
The upper end of the humerus joins with the shoulder blade at the socket provided by the glenoid. Fractures can occur in this area. These fractures can be in two parts or more. The various bony prominences at the upper end have muscle attachments. The blood supply of the upper end comes along with these muscles. When fracture occurs, the blood supply can be disrupted. If these fractures are displaced then union can be delayed. These fractures can occur in the elderly osteoporotic patients. If these fractures are not treated properly then function of the arm is lost. The main function of the arm is to project the hand into space to reach out for food from the plate and deliver it to the mouth. Besides in elderly patients who are wheel chair bound the arm is a weight-bearing organ as it helps in transferring from the wheel chair to the bed or toilet seat.
Causes and risks
Falls on the outstretched arm can lead to fracture. Motor vehicle accidents are another cause. Osteoporosis is a contributory factor. Elderly patients are at risk.
Symptoms and signs
There is severe pain. Bruising may spread down the entire arm. There is loss of movement. There may be associated damage to the axillary nerve.
Diagnosis
Clinical signs are usually present. X rays are necessary to outline the pattern of the fracture.
Treatment
Can be conservative (non operative) if the fracture is not displaced. If the fracture is in many pieces or displaced, then usually some form of operation is required to position the pieces together so that the blood supply of the humerus is not jeopardized. In four part fractures the best treatment is a hemi arthroplasty (half shoulder replacement). The bone is osteoporotic and minimally invasive surgical methods are preferred by me. |
