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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
The patient may have suffered a number of possible injuries, although my primary diagnosis is an anterior shoulder dislocation. The patient has a characteristic history and the arm is held in a typical position suggesting shoulder dislocation, the vast majority of which are anterior. The patient may have suffered a proximal humerus fracture, though this is usually accompanied by bruising and swelling. There may be a clavicle fracture, which is not always obvious on clinical examination. I would also review imaging investigations to check for acromioclavicular joint separation, which commonly accompanies traumatic injuries to the shoulder.
Management of osteoporotic proximal humeral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
In the elderly, a proximal humeral fracture occurs usually after a simple fall, mostly from standing height. The clinical image is clear with pain, swelling, and disturbed shoulder function. The fracture can be diagnosed easily by conventional radiology. A standard anteroposterior and trans-scapular view are sufficient. The (modified) axial view makes it possible to evaluate the position of the tuberosities. In case of more fragment fracture types, a computed tomography (CT) scan allows for better evaluation of the fracture and different fragments and their dislocation.
Outcome after fracture
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Treatment and recovery from proximal humerus fractures depends in part on the degree of displacement of the fracture, as well as baseline function and comorbidities (see Chapter 20). For many proximal humerus fractures, the treatment that will lead to an optimal functional outcome is unclear.35 Whether or not a patient has surgical intervention, they are often limited initially in their weight-bearing status and range of motion. Physical and occupational therapy are important care components for return of function.36
30-day and 1-year mortality after skeletal fractures: a register study of 295,713 fractures at different locations
Published in Acta Orthopaedica, 2021
Camilla Bergh, Michael Möller, Jan Ekelund, Helena Brisby
In the upper extremities, the diaphyseal and distal humerus fractures were associated with an SMR of 11 and 7.0, respectively, at 30 days, and of 3.5 and 2.3, respectively, at 1 year. Proximal humerus fractures were associated with an SMR of 5.3 at 30 days and 2.0 at 1 year. These results are in accordance with previous studies on proximal humerus fractures (Bercik et al. 2013, Wilson et al. 2014). A higher mortality rate was also seen after scapular and clavicular fractures at 1 year, both locations demonstrating an SMR of 2 or higher. Distal fractures in the upper and lower extremities were associated with only minor increases in mortality rates. The second most common fracture, after hip fracture, in our study was wrist fracture. A similar or slightly lower mortality rate of 2.5% at 1 year was seen for this location compared with the previously reported 3–3.6% (Endres et al. 2006, Oyen et al. 2014) and associated with a low SMR (1.1).
Evidence-based orthopedics and the myth of restoring the anatomy
Published in Acta Orthopaedica, 2021
1st, best available evidence does not support surgery in this case. 2nd, clinical expertise is limited when it comes to severely displaced fractures managed nonoperatively. Experience is mainly surgical, and the vast majority of studies read in orthopedic departments are clinical series concerning surgical techniques and implants. 67% of the literature on proximal humerus fractures concerns operative treatments compared with 4% including nonoperative treatments (Slobogean et al. 2015). 3rd, patient values need to be explored. They are not accessible from radiographs or demographic data yet often form the basis for operative decisions. Many elderly patients with displaced fractures of the proximal humerus have limited interest in surgical interventions unless the surgeon states that this is the only way to regain function and quality of life. However, this answer is no longer compatible with best evidence. Surprisingly, and for unknown reasons, in many countries the use of surgery for fractures of the proximal humerus has increased for decades and seems to be continuing to increase (Huttunen et al. 2012, Sumrein et al. 2017, Sabesan et al. 2017, Jo et al. 2019, Klug et al. 2019).
A concept analysis and overview of outcome measures used for evaluating patients with proximal humerus fractures
Published in Disability and Rehabilitation, 2021
Lauren L. Nowak, Aileen M. Davis, Muhammad Mamdani, Dorcas Beaton, Emil H. Schemitsch
Proximal humerus fractures are one of the most common fragility fractures in older adults [1], typically occurring after a low-energy fall onto an outstretched arm [2]. Unfortunately, there remains significant controversy surrounding the optimal management of these injuries, despite several randomized trials comparing different treatment options [3]. Evidence based decisions stemming from these trials are difficult to make in large part because of the heterogeneity in what are included as primary or secondary outcomes, and how they are measured [3–7]. Furthermore, due to a lack of standardization in the outcomes used, there is a risk of selective outcome reporting bias. Current studies include several combinations of clinician-measured and patient-reported functional (both shoulder specific and upper extremity specific), general health state, pain, and radiographic measures [3].