Conservative Treatment for Bilateral Displaced Proximal Humerus Head Fracture

Abstract

Proximal humerus fracture represents five to eight percent of all fractures and is twice as common in women than in men. Most cases of displaced fracture of the proximal humerus are treated surgically; it is probable that more cases are preferred to be treated surgically greater than required. The optimal treatment for these fractures remains controversial, but physicians have a tendency to treat via open reduction and fixation with angular locking plates or glenohumeral arthroplasty. We present a case of a 71-year-old woman with bilateral displaced proximal humeral fracture. Conservative treatment was initiated with two hanging casts, achieving radiological reduction on week one. After two additional weeks of casting, treatment continued with radiologic control and home physical therapy, ultimately an excellent functional outcome and adequate radiological reduction was obtained. Even in bilaterally displaced proximal humerus fractures, conservative treatment can be an efficient option, reducing complications, reaching adequate functional results and acceptable radiographic reduction.​

Simultaneous ORIF for bilateral comminuted proximal humerus fractures: Case report in an elderly patient

“…Rodrigues-Crolay (2016) employed conservative treatment with two hanging casts and a radiological treatment conducted during the first week and after two additional weeks. Satisfactory results were reported, showing that conservative treatment can also be a viable treatment option in such cases [1]. A study by Dixit et al (2013) examined the Nationwide Inpatient Sample (NIS) in the United States in order to make a comparison between ORIF and arthroplasty treatments.…”

“…Around five to eight percent of fracture cases include proximal humerus fractures [1]. In young patients, this type of fracture is often caused due to high energetic traumas, as well as in subjects presenting with convulsions and electrocution.…”

“…They can often occur as results of epileptic episodes, electrocution or extreme traumas [3]. In most cases, proximal humerus fractures are surgically treated [1]. We present a case of an elderly woman who sustained trauma post fall to both her shoulders, found to have simultaneous bilateral comminuted proximal humeral fractures.…”

Bilateral Reverse Total Shoulder Arthroplasty with Soft Tissue Release for Bilateral Posterior Fracture Dislocation after Status Epilepticus

“…Proximal humerus fractures constitute a fair proportion of worldwide reported fracture cases, with a 5-8% frequency [ 1 ] (incidence: 82 per 100,000 per year [ 2 ]). A bimodal distribution may be described.…”

Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report

“…An increasing number of Authors suggest reverse shoulder arthroplasty (RSA) as a valid option instead of hemiarthroplasty (HA) or open reduction and internal fixation (ORIF) for the treatment of displaced fractures of humeral head in this population [[10], [11], [12], [13]], and a multicenter combined randomized controlled and observational trial on this issue has started [14]. In the rare situation of simultaneous bilateral proximal humeral fracture, choice of treatment is still more controversial, and it can vary from conservative management [15] to closed reduction and percutaneous fixation [16] to ORIF of one or both sides [17], to HA of one side associated to conservative treatment [18] or ORIF [5,18] or osteochondral autograft [19] of the contralateral side, to even bilateral HA [20,21].…”