Unseparated (displaced) Shoulder Fractures
Fractures not separated (displaced) in either the humerus or glenoid can be treated with:
- Sling for pain control
- Controlled early passive motion exercises
X-rays will be used to assess the fracture healing. Typically, 8 weeks after injury active arm motion exercises begin. A Physical Therapist will guide the therapy protocol until normal activity can be achieved, usually six months after injury.
3 Part (or higher) Shoulder Fractures
If fracture fragments of the humerus number more than two and are significantly separated, the fracture is considered unstable and surgery is recommended. This enables the shoulder fracture to heal properly to useful arm function.
Surgery in Patients With:
Strong Bone Quality: Fractures are fixed with the use of modern plates and screws that lock to each other and hold the fragments together while healing.
Poor Bone Quality: A three or four part fracture, with or without a joint dislocation or a break involving the joint surface, is indicated for a shoulder replacement (hemi-arthroplasty).
Very Weak Bone Quality: When the patient is elderly and the bone is very weak with a poor likelihood of success with a hemi-arthroplasty, a reverse shoulder arthroplasty is the best first surgical option. Need a description of a reverse shoulder arthroplasty.
The standard fracture hemi-arthroplasty allows for the bone fragments to be fixed to the implant while the bone heals. Need a description of the implant.Implants are usually cemented in the humeral canal with cement called methylmethacrylate. Newer implants have recently been developed that do not require bone cement.
A fracture hemi-arthroplasty is a difficult operation and only those surgeons with the proper training who perform these operations on a routine basis should perform this surgery.