31 Oct Complex fracture of Humerus
Dr. Xavier Piqueres, specialist in pathology of the upper limb, tells us about the current treatment of complex fractures of the proximal end of the humerus.
Most fractures of the proximal end of the humerus can follow a conservative treatment, but the poor functional outcome of complex fractures makes surgical treatment necessary. In young patients, osteosynthesis will always be the first option, but in patients of more advanced age, the poor result of osteosynthesis and the difficulty of a second rescue surgery demonstrated in the literature, makes us opt as the first-choice treatment for the prosthesis. of substitution
The treatment for years by partial replacement prosthesis has shown us that the functional result in this type of intervention depends directly on the consolidation of the greater tuberosity or troquiter around the prosthesis, and the literature describes more than 50% of complications, that makes the functional outcome of the surgery unpredictable and calls into question the current indication of this treatment. In elderly patients, female sex and comminution of the greater tuberosity, the poor result of this surgery has led us to modify the surgical indication.
The use of a total inverted prosthesis in the surgical treatment of complex fractures of the proximal humerus eliminates the need for the consolidation of the tuberosities to obtain a correct functional result. Another important advantage in this type of surgery is the postoperative comfort, since the patient does not need to keep the operated limb immobilized 4 or 6 weeks, allowing the use of extrimity for the basic needs of daily life from the day after the intervention. how to wash, dress and eat, advising to keep the arm in a sling the first 10 or 15 days for comfort. The majority of patients require minor analgesics in the immediate postoperative period and achieve a correct functional result of the operated limb 3 months after surgery with a self-assisted physiotherapy program. The realization of a specific rehabilitation treatment in a specialized center reduces postoperative pain and speeds up functional recovery.
The inverted total prosthesis is also the treatment of choice in patients with osteoarthritis of the shoulder with rupture of the rotator cuff, obtaining excellent functional results and the immediate disappearance of joint pain.