The Shoulder is a ball and socket. Fractures of the ball (humeral head) are one of the most frequently encountered fractures in the elderly. In the elderly, poor bone quality compounds the problem. Fractures of the humeral head in the young are generally the consequence of severe trauma such as road traffic accidents.
As far as possible, attempts are made to preserve the humeral head. Fractures with minimal displacement (where the bones are well aligned) can be treated in a comfortable shoulder sling. Shoulder movements are started early to avoid stiffness.
Displaced fractures can be treated in several ways depending upon the number of fragments and quality of bone. Some fractures are fixed with wires inserted without incisions under x ray control. These wires protrude from the skin and are removed in the consultation rooms at approximately 3-4 weeks.
Fractures with severe displacement require open surgery and are fixed with specially designed plates and screws. These implants do not interfere with shoulder movement and need not be removed.
Fractures with several small pieces (comminution) which are displaced are difficult to treat. Attempts are made at preserving and fixing these pieces.
However, this is not always possible. In such cases, the ball is best replaced. This is a decision best made by a Specialist Shoulder Surgeon. Such replacements, if required, demonstrate best results if done within 3 weeks of the injury. Pain relief is immediate. However, do not expect full range of motion after treatment of such fractures – by fixation or replacement.
Fractures of the socket are rare. Most of them are not displaced and can thus be treated in a comfortable shoulder sling for 3 weeks. Range of motion exercises are then started. The rare, displaced ones might require surgical fixation with special screws and plates.
WHAT IS IMPORTANT :
Irrespective of the way fractures are managed, it is well accepted by Specialist Shoulder Surgeons that early mobilisation is mandatory. The shoulder joint is notorious at becoming stiff if not mobilised within 3-4 weeks of surgery. Stable, minimal fixation followed by early mobilisation achieves best results.