DOCSLIB.ORG

Predictors of Mortality in Elder Patients with Proximal Humeral Fracture

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Predictors of Mortality in Elder Patients with Proximal Humeral Fracture Original Article Geriatric Orthopaedic Surgery & Rehabilitation 1-6 Predictors of Mortality in Elder Patients ª The Author(s) 2017 Reprints and permission: With Proximal Humeral Fracture sagepub.com/journalsPermissions.nav DOI: 10.1177/2151458517728155 journals.sagepub.com/home/gos Chad M. Myeroff, MD1, Jeffrey P. Anderson, ScD, MPH2, Daniel S. Sveom, MD1, and Julie A. Switzer, MD1,3 Abstract Background: Known possible consequences of proximal humerus fractures include impaired shoulder function, decreased independence, and increased risk for mortality. The purpose of this report is to describe the survival and independence of elderly patients with fractures of the proximal humerus, treated in our institution, relative to patient characteristics and treatment method. Methods: Retrospective cohort study from 2006 to 2012. Setting: Community-based hospital with level 1 designation. Patients/Participants: Three hundred nineteen patients 60 years who presented to the emergency department with an isolated fracture of the proximal humerus were either admitted to the inpatient ward for the organization and provision of immediate definitive care or discharged with the expectation of coordination of their care as an outpatient. Treatment was nonoperative or operative. Outcome Measures: One- and 2-year mortality. Results: Significant predictors of mortality at 1 year included Charlson Comorbidity Index (CCI; continuous, hazard ratio [HR] ¼ 1.40; 95% confidence interval [CI]: 1.06-1.86), body mass index (BMI; <25 vs 25; HR ¼ 3.43; 95% CI: 1.45-8.14), and American Society of Anesthesiologists (ASA) disease severity score (3-4 vs 1-2; HR ¼ 4.48; 95% CI: 1.21-16.55). In addition to CCI and BMI, reliance on a cane/walker/wheelchair at the time of fracture predicted mortality at 2 years (vs unassisted ambulation; HR ¼ 3.13; 95% CI: 1.59-5.88). Although the Neer classification of fracture severity significantly correlated with inpatient admission (P < .001), it was not significantly associated with mortality or with loss of living or ambulatory independence. Among admitted patients, 64% were discharged to a facility with a higher level of care than their prefracture living facility. Twenty percent of study patients experienced a loss in ambulatory status by at least 1 level at 1 year postfracture. Conclusion: In a cohort of elderly patients with fractures of the proximal humerus, patient characteristics including comorbidities, ASA classification, and lower BMI were associated with increased mortality. Specifically, those admitted at the time of fracture and treated nonoperatively had the highest mortality rate and, likely, represent the frailest cohort. Those initially treated as outpatients and later treated operatively had the lowest mortality and, likely, represent the healthiest cohort. These data are inherently biased by prefracture comorbidities but help stratify our patients’ mortality risk at the time of injury. Keywords geriatric trauma, trauma surgery, upper extremity surgery, fragility fractures, osteoporosis, mortality, proximal humerus fracture, hospital admission Submitted May 23, 2017. Revised July 22, 2017. Accepted July 22, 2017. Introduction bearing, surgical repair within 48 hours, and the stratification of risk relative to age and comorbidities.5-10 In contrast to this Proximal humerus fractures are the third most common fracture work in hip fracture care, relatively little analogous data exist in patients over the age of 65.1 Historically, these patients have been considered to be more robust than patients with hip frac- 2-3 tures but frailer than patients with distal radius fractures. 1 Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Although the incidence of these fractures is rising, only sparse MN, USA literature addresses the significance of this injury in elderly 2 HealthPartners Institute, Bloomington, MN, USA individuals, especially in frail elderly individuals.4 3 Department of Orthopaedic Surgery, Regions Hospital, St Paul, MN, USA During previous decades, the implication of hip fractures on Corresponding Author: morbidity and mortality has been well studied and has also Julie A. Switzer, Department of Orthopaedic Surgery, Regions Hospital, 640 driven care. Examples of this effect include the development Jackson St, MS11503L, St Paul, MN 55101, USA. of hip fracture protocols that prescribe immediate full weight Email: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 Geriatric Orthopaedic Surgery & Rehabilitation Figure 1. Illustration of ambulatory status and living independence levels. to help counsel elderly patients regarding survival or living independence following a fracture of the proximal humerus. The primary aim of this study was to identify risk factors for Figure 2. Study sample and clinical management. mortality in elderly patients with proximal humeral fracture. Secondarily, we investigated correlates in patient characteris- classification schemes.11,12 Mortality was captured from the tics and patient outcomes. Specifically, we examined mortality EMRs when documented or from Ancestry.com, if date of death in elderly patients with isolated fractures of the proximal was not recorded in the EMRs or if clinical activity was not humerusinrelationtopatientfactors including comorbid documented beyond 2 years of fracture. Those not identified as conditions, body mass index (BMI), hospital admission deceased at 1-year or 2-year postinjury by the EMRs or Ances status, treatment method, level of discharge facility, and level try.com were assumed to be alive at that point. 13,14 of prefracture patient independence. Statistical Methods Patients and Methods Descriptive statistics were used to summarize the patient The research was performed at a community-based hospital with population as well as changes in living and ambulatory status level 1 trauma center designation. By searching Current Proce- pre- and postfracture. Cox proportional hazards regression dural Terminology and International Classification of Diseases, analysis evaluated 1-year and 2-year mortality in relation to Ninth Revision codes, we identified 648 patients aged 60 years patient factors with results reported as hazard ratios (HRs) with with fractures of the proximal humerus, treated between 95% confidence intervals (CIs). For all other outcomes, we 2006 and 2012. Eligible study patients were 60 years old with constructed multivariable generalized linear regression models an isolated and unilateral fracture of the proximal humerus. to calculate b estimates (continuous outcomes) or odds ratios Exclusion criteria included polytrauma patients, bilateral (ORs; binary outcomes). Independent variables for final fractures, shoulder dislocations, and pathologic fractures. adjusted models were chosen from a pool of a priori defined Admission, at the discretion of the emergency department covariates using a stepwise selection algorithm. All statistical (ED), orthopaedic, or medical attending physician, was typically analyses were carried out with SAS (v9.4) software. secondary either to a degree of social or medical dependence or to plans for early operative intervention. Fracture care was at the discretion of the treating senior author (JAS). Results Three hundred nineteen patients aged 60 and over with A total of 319 patients, who were treated for fracture of the isolated fractures of the proximal humerus met the inclusion proximal humerus between January 2006 and April 2012, met criteria. Data were collected retrospectively from the electronic study inclusion criteria. One hundred twenty-one (38%) were medical records (EMRs). The information obtained included gen- admitted as inpatients from the ED, while the remaining 198 eral patient demographics, admission status, treatment method, were discharged from the ED. Patients in both groups were length of stay, discharge facility, prefracture level of indepen- treated operatively and nonoperatively for their isolated prox- dence, residence at 1-year postinjury, ambulatory status at 1-year imal humerus fracture, as shown in Figure 2. postinjury, and mortality at 1-year and 2-year postinjury. Comor- The average age of the study cohort was 75 years (range: 60- bidities were captured using the Charlson Comorbidity Index 97), and 76% were female. The majority of the patients (n ¼ 196, (CCI) and American Society of Anesthesiologists (ASA) score. 63%) were fully ambulatory (without assistance) prior to fracture Changes in living and ambulatory status were ranked as “worse” and 72% (n ¼ 227) lived independently in private homes without or “same or better” (Figure 1). Fractures were classified accord- assistance. According to Neer classification, 35% of these ing to both Neer and Orthopedic Trauma Association (OTA) patients were type 1, 52% were type 2, 9% were type 3, and 4% Myeroff et al 3 Table 1. Patient Demographics and 1-Year Mortality Stratified by Patient Characteristics. Admitted From ED Discharged From ED Nonoperative Operative Nonoperative Operative Variable Total, N (%) n Deaths (%) n Deaths (%) n Deaths (%) n Deaths (%) Total 319 (100) 60 9
Load more

Recommended publications
  • Fragility Fractures and Imminent Fracture Risk in Hong Kong: One of the Cities with Longest Life Expectancies
    Archives of Osteoporosis (2019) 14:104 https://doi.org/10.1007/s11657-019-0648-4 ORIGINAL ARTICLE Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies Ronald Man Yeung Wong1 & Wing Tung Ho1 & Law Sheung Wai1 & Wilson Li2 & Wai Wang Chau1 & Kwoon-Ho Simon Chow1 & Wing-Hoi Cheung1 Received: 6 May 2019 /Accepted: 27 August 2019 # International Osteoporosis Foundation and National Osteoporosis Foundation 2019 Abstract Introduction Imminent fracture risk, or fractures within 2 years of an initial fracture, is a pressing issue worldwide. Hong Kong is a city with one of the longest life expectancies. The concern of fragility fractures and the imminent risk of a subsequent fracture is becoming a top priority. The objective of this study was to present the epidemiology of incident fragility fractures of all public acute hospitals and the imminent risk of a subsequent fracture in Hong Kong. Methodology This was a retrospective population-based analysis. Patient records from all acute hospitals in Hong Kong from 1 January 2004 to 31 December 2018 were retrieved for patients ≥ 50 years of age with hip, distal radius, or proximal humerus fractures. Secondary fractures and falls were identified in the subsequent 5 years. Post hoc analysis in recent 2013–2018 period was performed. Overall survival (re-fracture incidence) on age subgroups using Kaplan survival analysis and variables was compared using the log-rank test. Cox proportional hazard regressions, obtaining the hazard ratios (HR) and their respective 95% confidence intervals (CI), were used. Results There is an overall increasing trend of fragility fractures (hip, distal radius, proximal humerus) from 5596 in 2004 to 8465 in 2018.
    [Show full text]
  • Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction with Total Elbow Arthroplasty Dawn M
    (aspects of trauma • an original study) Distal Humerus Nonunion After Failed Internal Fixation: Reconstruction With Total Elbow Arthroplasty Dawn M. LaPorte, MD, Michael S. Murphy, MD, and J. Russell Moore, MD ABSTRACT onunion occurs in 2% ing treatment option. In the 1980s, In nonunion after distal humerus to 5% of distal humerus TEA for nonunion with tightly con- fracture, osteoporosis, devas- fractures.1 The condition strained or custom prostheses had cularized fracture fragments, is difficult to treat, and fair to moderately good results but and periarticular fibrosis limit Nno single treatment modality has a high complication rates (4/7, 57%6; potential reconstructive options. high success rate with few compli- 5/14, 36%10). According to a recent We assessed pain relief, func- 2-6 11 tional gains, and complications cations. Without intervention, the review, however, 31 (86%) of 36 in 12 patients whose long-stand- patient is left with a painful, unstable, patients had a satisfactory result with ing, painful nonunions after previ- and often flail extremity and with a semiconstrained prosthesis, and ous treatment with rigid internal limitations in activities of daily liv- only 7 (19%) of the 36 patients had fixation were reconstructed with ing. Frequently, there is an associ- complications. a semiconstrained total elbow ated ulnar neuropathy. Osteoporosis, In the current study, we assessed arthroplasty, frequently with a devascularized fracture fragments, outcomes (complications, symptoms, triceps-sparing approach and and periarticular fibrosis limit poten- function) after semiconstrained anterior ulnar nerve transposition. tial reconstructive options for long- TEA for long-standing distal humer- At mean follow-up of 63 months, 11 patients had good pain relief and standing distal humerus nonunions.
    [Show full text]
  • Pseudogout at the Knee Joint Will Frequently Occur After Hip Fracture
    Harato and Yoshida Journal of Orthopaedic Surgery and Research (2015) 10:4 DOI 10.1186/s13018-014-0145-9 RESEARCH ARTICLE Open Access Pseudogout at the knee joint will frequently occur after hip fracture and lead to the knee pain in the early postoperative period Kengo Harato1,3*† and Hiroki Yoshida2† Abstract Background: Symptomatic knee joint effusion is frequently observed after hip fracture, which may lead to postoperative knee pain during rehabilitation after hip fracture surgery. However, unfortunately, very little has been reported on this phenomenon in the literature. The purpose of the current study was to investigate the relationship between symptomatic knee effusion and postoperative knee pain and to clarify the reason of the effusion accompanied by hip fracture. Methods: A total of 100 patients over 65 years of age with an acute hip fracture after fall were prospectively followed up. Knee effusion was assessed on admission and at the operating room before the surgery. If knee effusion was observed at thetimeofthesurgery,synovialfluidwascollectedintosyringes to investigate the cause of the effusion using a compensated polarized light microscope. Furthermore, for each patient, we evaluated age, sex, radiographic knee osteoarthritis (OA), type of the fracture, laterality, severity of the fracture, and postoperative knee pain during rehabilitation. These factors were compared between patients with and without knee effusion at the time of the surgery. As a statistical analysis, we used Mann–Whitney U-test for patients’ age and categorical variables were analyzed by chi-square test or Fisher’sexacttest. Results: A total of 30 patients presented symptomatic knee effusion at the time of the surgery.
    [Show full text]
  • Treatment of Common Hip Fractures: Evidence Report/Technology
    This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA 290 2007 10064 1). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. Evidence Report/Technology Assessment Number 184 Treatment of Common Hip Fractures Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. HHSA 290 2007 10064 1 Prepared by: Minnesota Evidence-based Practice Center, Minneapolis, Minnesota Investigators Mary Butler, Ph.D., M.B.A. Mary Forte, D.C. Robert L. Kane, M.D. Siddharth Joglekar, M.D. Susan J. Duval, Ph.D. Marc Swiontkowski, M.D.
    [Show full text]
  • Fractures of the Proximal Humerus
    Fractures of the Proximal Humerus David Rothberg, MDa,*, Thomas Higgins, MDb KEYWORDS Proximal humerus fracture Neer classification Fibular strut Shoulder arthroplasty KEY POINTS Proximal humeral fractures are common. Classification systems have evolved to develop treatment guidelines. Bone quality must be considered for treatment. Surgical stabilization may require augmentation. Arthroplasty must be considered especially in the elderly. INTRODUCTION common osteoporotic extremity fracture after hip fractures and distal radius fractures.1 Greater Proximal humeral fractures are common, with low- than 70% of these fractures occur in patients older energy injuries occurring in the elderly population than 60 years, with a 4:1 female/male ratio and an and less frequent higher-energy fractures striking incidence steadily increasing after the age of 40 young people. The decision to pursue operative years. or nonoperative treatment is driven by the func- Independent risk factors for proximal humeral tional goals and the degree of displacement of fractures include a recent decline in health status, the proximal humeral anatomic parts. Operative insulin-dependent diabetes mellitus, infrequent management is based on the ability to obtain walking, indicators of neuromuscular weakness, and maintain reduction, vascularity of the articular diminished femoral neck bone density, height/ segment, quality of soft-tissue attachments, and weight loss, previous falls, impaired balance, and bone porosity. Despite much study, the optimal maternal history of hip fractures.2 In a 3-decade treatment of significantly displaced fracture population-based study of osteoporotic proximal patterns remains controversial. humeral fractures, Palvanen and colleagues3 found that the incidence in patients older than 60 EPIDEMIOLOGY years increased by 13.7% per year of age.
    [Show full text]
  • Non-Union Humeral Shaft Fracture with Hardware Failure
    Non-Union Humeral Shaft Fracture with Hardware Failure Molly Hovendick, MAT, ATC, LAT., Northeastern State University Dylan Morris, DO., Oklahoma State University- Center for Health Sciences Matthew O’Brien, PhD, ATC, LAT., Oklahoma State University- Center for Health Sciences Introduction: Humeral shaft fractures account for three to five percent of all fractures. The unique aspect of this case was the patient suffered from a nonunion humeral fracture and subsequently suffered from surgical hardware failure as well. Background: The patient is a right hand dominant 66-year-old male who presented to the emergency department with left arm pain and disability due to a fall from standing height. Initially, he was treated conservatively and placed into a functional brace. At the follow up visit approximately one month later, he reported continued pain and discomfort in his upper extremity. Although there was concern of a possible delayed union due to a history of cigarette smoking and possible noncompliance with post- operative restrictions the patient elected to proceed with open reduction internal fixation (ORIF) the following day. Shortly following surgery, the patient reported a fall reinjuring his left shoulder while mowing his lawn. Previous symptoms were aggravated and signs of hardware failure through the locking plate was suspected. The decision to perform revision ORIF of the fracture using interfragmentary compression plating with lag screw fixation and bone grafting was made and performed approximately seven months following the initial surgery. Discussion: This case report highlights that while the majority of humeral shaft fractures can successfully be treated conservatively, this method may fail and require delayed open reduction internal fixation.
    [Show full text]
  • Fracture Lower Extremity Part II
    CONTENTS FEMUR SHAFT BOTH BONE SUBTROCHANTERIC TIBIAL PLAFON FRACTURE LOWER FRACTURE ANKLE EXTREMITIES: PART 2 FRACTURE FEMUR FOOT SUPRACONDYLAR FRACTURE FEMUR CALCANEUS PATELLA TALUS WORAWAT LIMTHONGKUL, M.D. 14 JAN 2013 TIBIA LISFRANC’S TIBIAL PLATEAU METATARSAL 1 2 SUBTROCHANTERIC FRACTURE FEMUR A PART OF FRACTURE OCCUR BETWEEN TIP OF LESSER TROCHANTER AND A POINT 5 SUBTROCHANTERIC CM DISTALLY CALCAR FEMORALE FRACTURE LARGE FORCES ARE NEEDED TO CAUSE FRACTURES IN 5 CM YOUNG & ADULT INJURY IS RELATIVELY TRIVIAL IN ELDERLY 2° CAUSE: OSTEOPOROSIS, OSTEOMALACIA, PAGET’S 3 4 SUBTROCHANTERIC FRACTURE FEMUR TREATMENT INITIAL FEMUR SHAFT TRACTION DEFINITE FRACTURE ORIF WITH INTRAMEDULLARY NAIL OR 95 DEGREE HIP- SCREW-PLATE 5 6 FEMUR FRACTURE FILM HIPS SEVERE PAIN, UNABLE TO BEAR WEIGHT 10% ASSOCIATE FEMORAL SUPRACONDYLAR NECK FRACTURE FEMUR FRACTURE TREATMENT: ORIF WITH IM NAIL OR P&S COMPLICATION: HEMORRHAGE, NEUROVASCULAR INJURY, FAT EMBOLI 7 8 SUPRACONDYLAR FEMUR FRACTURE SUPRACONDYLAR ZONE DIRECT VIOLENCE IS THE USUAL CAUSE PATELLA FRACTURE LOOK FOR INTRA- ARTICULAR INVOLVEMENT CHECK TIBIAL PULSE TREATMENT: ORIF WITH P&S 9 10 PATELLA FRACTURE PATELLA FRACTURE FUNCTION: LENGTHENING THE ANTERIOR LEVER ARM DDX: BIPATITE PATELLA AND INCREASING THE (SUPEROLATERAL) EFFICIENCY OF THE QUADRICEPS. TREATMENT: DIRECT VS INDIRECT NON-DISPLACE, INJURY INTACT EXTENSOR : CYLINDRICAL CAST TEST EXTENSOR MECHANISM DISPLACE, DISRUPT EXTENSOR: ORIF WITH VERTICAL FRACTURE: TBW MERCHANT VIEW 11 12 PATELLAR DISLOCATION ADOLESCENT FEMALE DISLOCATION AROUND USUALLY
    [Show full text]
  • Appendix 12 the Profher Trial Sling Immobilisation Leaflet
    DOI: 10.3310/hta19240 HEALTH TECHNOLOGY ASSESSMENT 2015 VOL. 19 NO. 24 Appendix 12 The ProFHER trial sling immobilisation leaflet Fractured Proximal Humerus Information for patients on initial self-care You have been given this leaflet because the top end of your upper arm bone is broken. This is called a 'proximal humerus fracture'. This leaflet is to remind you of the advice on self-care that you will receive from your hospital staff. Members of staff will be 1a happy to explain any of the matters raised in this leaflet and you can also ask your family doctor (GP) for further advice when you have left hospital. This leaflet covers the first few weeks after your injury when your arm is in a sling. People are usually advised to wear their sling for about three weeks. The sling will ease Swathe the pain and help the bone and soft tissues to heal, so it is important that you wear it Sling both day and night. The sling should support the weight of your arm. In some hospitals, depending on the consultant’s preference, the sling is secured by a ‘swathe’. In others, a ‘collar and cuff’ is used instead of a sling. A well-positioned sling and swathe should look like diagram 1a. Diagram 1b shows a sling without a swathe, and diagram 1c shows a collar and cuff. In the following sections we tell you things you should DO, including some tips on pain ! relief and on how you can make yourself ! more comfortable, things you should NOT ! 1b ! 1c DO, and things you MUST TELL YOUR ! HOSPITAL STAFF OR FAMILY ! DOCTOR (GP) ABOUT.
    [Show full text]
  • Medical Consultation for the Elderly Patient with Hip Fracture
    J Am Board Fam Pract: first published as 10.3122/15572625-11-5-366 on 1 September 1998. Downloaded from CLINICAL REVIEW Medical Consultation for the Elderly Patient With Hip Fracture RichardJ Ackermann, MD Background: This article describes a family physician geriatrician's perspective on the comprehensive management of hip fracture in frail elderly patients. Primary care physicians might be called upon to pro­ vide medical consultation for these patients. Methods: Guidelines were developed by a combination of personal experience in consulting for several hun­ dred elderly patients with hip fracture at a large community hospital, literature review using the key words "hip fractures," "aged," and "aged, 80 and over," and educational presentations for family practice residents. Results and Conclusions: Elderly patients with hip fracture offer a prime opportunity for comprehensive geriatric assessment. Intertrochanteric fractures are almost always treated with internal fixation, whereas femoral neck fractures can be treated by either fixation or by hemiarthroplasty. Hip fracture should be re­ garded as a surgical urgency, and generally operation should not be delayed, even if patients have serious comorbidity. The family physician can be instrumental in preparing the patient for surgery, preventing and treating complications, and assisting in the placement and rehabilitation of patients after hospital dis­ charge. 0 Am Board Fam Pract 1998; 11:366-77.) As the result of an aging population, family physi­ Some hip fractures and the falls that precede cians are increasingly likely to participate in the them are probably preventable. Strategies to de­ care of elderly patients suffering hip fracture. This tect and treat osteoporosis, especially in high-risk copyright.
    [Show full text]
  • What You Should Know About Hip Fractures
    Information O from Your Family Doctor What You Should Know About Hip Fractures What is a hip fracture? surgery. It may involve putting pins, rods, and A hip fracture is a break in the top of your plates into the hip joint. Some hip fractures are upper leg bone near the hip joint, just below treated with a hip replacement. The orthopedic the waist. The type of hip fracture depends surgeon will help decide which surgery is best on which part of the bone breaks. Most hip for you. fractures are caused by a fall in people 65 years or older. People with weak bones, known as What happens next? osteoporosis (OSS-tee-oh-puh-RO-sis), are You will need to work with a physical therapist more likely to break a hip. at home, in the therapist’s office, or in a skilled nursing facility to regain use of your hip. You will What are the symptoms? practice bending, walking, and climbing stairs. The most common symptom is pain in the hip For most patients, your doctor will or groin area. The pain is usually worse when recommend a medicine called a bisphosphonate you try to move the hip. There is a lot of pain (bis-FOSS-fuh-nate). This is taken by mouth. when you walk. Most people cannot walk with It can help lower your chance of another hip a hip fracture. fracture. How is it found? How can hip fractures be prevented? An x-ray can show if the hip is broken and You can prevent falls by talking to your doctor which part of the bone is fractured.
    [Show full text]
  • Proximal Humerus Fracture (Conservative Management) 1 and 2-Part Fractures This Leaflet Provides More Information About Proximal Humerus Fractures
    Proximal Humerus Fracture (Conservative Management) 1 and 2-part fractures This leaflet provides more information about proximal humerus fractures. If you have any further questions or concerns, please speak to the Physiotherapy Department, Ground Floor, St James Wing, St George’s Hospital. What is proximal humerus fracture and why have I got it? Your shoulder is a ball and socket joint made up of the upper arm bone (humerus) and shoulder blade (scapula). Your injury is a break or fracture to the upper or ‘proximal’ part of the humerus bone. Proximal humerus fractures are common. They are the third most common fracture type in individuals over 65 years of age and may occur when falling on to your arm. Your fracture will be confirmed on x-ray. What are the signs and symptoms? Pain Bruising and swelling Difficulty moving your arm Apprehension and anxiety about moving your arm. What to expect? Proximal humerus fractures are often linked to shoulder stiffness. Following this type of injury the main aim is to regain enough movement to perform day to day activities and help may be required initially. 1- and 2-part fractures can be managed successfully without an operation. Proximal humerus fractures will heal, typically within 6-12 weeks, even if the humerus is broken into two parts. Recovery can take up to six months, occasionally longer, for your symptoms to settle completely. Do I need any tests to confirm the diagnosis? If it is suspected that you have a proximal humerus fracture an x-ray and clinical assessment by a doctor in the emergency department would confirm your diagnosis.
    [Show full text]
  • Management of Proximal Humeral Fractures Based on Current Literature
    This is an enhanced PDF from The Journal of Bone and Joint Surgery The PDF of the article you requested follows this cover page. Management of Proximal Humeral Fractures Based on Current Literature Shane J. Nho, Robert H. Brophy, Joseph U. Barker, Charles N. Cornell and John D. MacGillivray J Bone Joint Surg Am. 2007;89:44-58. doi:10.2106/JBJS.G.00648 This information is current as of October 8, 2007 Reprints and Permissions Click here to order reprints or request permission to use material from this article, or locate the article citation on jbjs.org and click on the [Reprints and Permissions] link. Publisher Information The Journal of Bone and Joint Surgery 20 Pickering Street, Needham, MA 02492-3157 www.jbjs.org Nho_00648.fm Page 44 Monday, September 10, 2007 2:01 PM 44 COPYRIGHT © 2007 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED Management of Proximal Humeral Fractures Based on Current Literature By Shane J. Nho, MD, MS, Robert H. Brophy, MD, Joseph U. Barker, MD, Charles N. Cornell, MD, and John D. MacGillivray, MD Introduction greater tuberosity fractures, an anterosuperior approach roximal humeral fractures are the second most com- along the Langer lines extending from the lateral aspect of mon upper-extremity fracture and the third most com- the acromion toward the lateral tip of the coracoid is used. Pmon fracture, after hip fractures and distal radial The split occurs in the anterolateral raphe and allows expo- fractures, in patients who are older than sixty-five years of sure of the displaced greater tuberosity fracture.
    [Show full text]