1. 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

2. 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

3. 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

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

5. Pain is acceptable
Day 5

6. Moderate function
3 weeks

7. 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).

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

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

10. 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.

11. Thank you
Return to list of cases
End of case 10