Case 10 (b) Proximal humeral fracture Case 10 learning objectives: Discuss operative and nonoperative treatment options Discuss the impact of further information on the management of complex fragility fracture patients Discuss the pain treatment Discuss the risk factors for delirium, the use of restraints, and family support Discuss the results of lab tests and the indication of antibiotic treatment Recognize the value and process of shared decision making Discuss the treatment of delirium AOTrauma Course Fragility Fractures and Orthogeriatrics

Case description 78-year-old woman Simple fall at home She complains of massive pain in the left shoulder and some pain in the pelvis Comorbidities: none mentioned, no drug treatment Diagnosed with osteoporosis for spine and osteopenia for hip Osteoporosis/osteopenia discovered and treated 6 months before fall

Case description T score -3,6 T score -2,2 Osteoporosis/osteopenia discovered and treated 6 months before fall Diagnosed with osteoporosis for spine and osteopenia for hip

Simple fall at home Day 0 Pain left shoulder, neurovascular not compromised, closed injury

Pain is acceptable Day 5

Moderate function 3 weeks

Radiological outcome 6 months 480 Fractures healed in varus and some retroversion. Less than 55° of retroversion on transscapular view means good functional outcome (see reference).

Clinical outcome 6 months No complaints ADL active as before Abduction and endorotation are very acceptable. No complaints ADL active as before

Take-home messages Partially displaced 4-part fractures in older adults can be treated nonoperatively Amount of retroversion predicts outcome

References Poeze M, Lenssen AF, Van Empel JM, et al. Conservative management of proximal humeral fractures: can poor functional outcome be related to standard transscapular radiographic evaluation? J Shoulder Elbow Surg. 2010; 19(2):273−281.

Thank you Return to list of cases End of case 10