![]() Those are open fracture (where the fracture ends have pierced the skin) or nerve or blood vessel injury. There are really only a couple of absolute indications for surgery for this fracture. It may be clear from your injury whether you should have a sling for a few weeks before mobilising (moving) the shoulder gradually and allowing the fracture to heal naturally (nonoperative treatment), or whether surgery is either necessary or perhaps preferable. Once you come to clinic you will be given the chance to discuss your shoulder with a specialist in these injuries. It is better to wear the sling during the night in bed. If even this is too painful the wear the sling under the clothes. Feed your clothes onto your broken limb first then onto the unbroken side, with help. You don’t need to wear the sling under your clothes. It is ok to remove the sling for short periods to wash and dress. You may be supplied with a blue ‘polysling’ which are more substantial but don’t tend to allow gravity to ‘pull the fracture out’ quite so much. This mean that by the time you attend clinic and have another X-ray, your fracture may look slightly better, and it may even mean you can avoid surgery. By supporting the wrist and not the elbow, the action of gravity on the arm tends to pull the fracture out straight a little. This may feel like inadequate treatment of your significant injury but there is a good reason for this. The sling you are provided with may only be a pink foam sling that goes around your neck and around the wrist. Extensive bruising down the arm, even beyond the elbow, is common and can be alarming but it does settle in 2-3 weeks. It is uncommon to get paresthesia (pins and needles sensation) in the arm or hand with this injury. It’s a good idea to remove rings from fingers early on after injury as they can be difficult to remove after a day or so and they can compromise the blood supply to your fingers. This will settle in time but can take 4-6 weeks. The pain will be significant for about the first 3 weeks and is often accompanied by extensive bruising around the shoulder and down the arm and the arm will swell. You are then likely to be sent home from the Emergency Department and sent a clinic appointment. Struhl.If a doctor suspects that you may have fractured (broken) your shoulder, you will be sent for an X-ray and then placed in a sling. The multiple fragments are fixed with plates, screws, or pins and in severe cases a shoulder replacement surgery is performed.Ĭontact our orthopedic practice to schedule a consultation with Dr. Surgery may be necessary in displaced fractures. Most proximal humerus fractures are minimally displaced and can be treated with conservative approaches such as use of sling to immobilize and early physical therapy to improve the functional outcome. Proximal humerus fracture is diagnosed by physical examination, X-ray of the affected area and/or computerized tomography (CT) scan. Patients with proximal humerus fracture experience severe pain, swelling, and restricted motion of the shoulder. In addition to above, another type of proximal humerus fractures is two, three, and four part fractures, a fracture cause multiple fragmentation of the proximal humerus. These fractures occur in younger individuals by significant trauma whereas a mild traumatic injury can cause fracture in elderly individuals with osteoporosis. Humeral head fractures: Humeral head fractures are very often in elderly individuals and chances are more in those with osteoporotic bone.These fractures also damage the axillary nerve that carries sensory information from shoulder. Surgical neck fractures: Fractures of the surgical neck are most common in patients with osteoporotic bone.If left untreated, these fractures cause subscapularis muscle (stabilizer and mobilizer muscle) deficiency and requires a major muscle transfer procedure. Lesser tuberosity fractures: These fractures often caused by posterior shoulder dislocations or traumatic muscle contractions by electrical shock or convulsions.Direct impact to the shoulder causes the tuberosity bone to break into multiple fragments Partial rotator cuff tears often accompany non-displaced fractures and these fractures can be diagnosed using MRI or diagnostic arthroscopy. Greater tuberosity fragment is pulled off when cuff muscle contracts or anterior shoulder dislocates. Greater tuberosity fractures are less common and are seen in cases of shoulder dislocations and in those with osteoporosis. Greater tuberosity fractures: Greater tuberosity is the insertion site for attachment of rotator cuff tendons.Proximal humerus fractures can be categorized into 4 groups:
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