Complications of Fractures of Proximal Humerus
December 27, 2008 by Dr Arun Pal Singh
Filed under Humerus Fractures, Misc
Complications in fractures of proximal humerus are more likely after surgical than after nonoperative fracture care. Therefore a careful postoperative follow-up is necessary to note the complication at the earliest and intervene at the right time
Most common complications associated with fractures of proximal humerus are-
Instability
True glenohumeral instability is unusual after fractures. This usually results from muscle atony, blood in the joint, capsular tears, or any combination of these conditions. Treatment consists of sling support, deltoid isometrics, and observation. Instability should not be ignored.
Malunion
Incorrect diagnosis, poor reduction, inadequate fixation are frequent causes of malunion. Treatment depends on severity of the malunion. For less severity, the malunion can be left as such. Sevre malunions can be treated by release of adhesions with or without osteotomy. Trimming of prominences can also be considered.
Nonunion
Non union is rare in proximal humeral fractures. Early motion and poor bone stockare the fequent causes. It should be treated by surgical methods including humeral head replacement when necessary.
Avascular Necrosis
it is more common in three part and four part fractures. Most patients are followed and watched. Gentle stretching exercises and mild analgesics are the usual tratment inmost patients. If collapse occurs or pain becomes unbearable, humeral head replacement is considered. In case of development of glenoid arthritis, a total shoulder replacement considered.
Infection
Due to large envelope of soft issues infection in shoulder has a low rate. ANtibiotics, debridement and regular wound care are the basic management techniques.
Neurovascular injury
As many as 45% of patients with surgical neck fractures or glenohumeral dislocations have been found to have some degree of nerve injury. The risk is more in elderly patients or when a hematoma develops.
When associated with closed fracture, the prognosis for recovery is good, and observation is indicated. Splints may be used to support weak joints, and therapy is used to maintain passive motion.
In case of injury occurs after a surgical procedure or after a manipulation, exploration may have to be considered.
Arterial injury from displaced fractures is common especially in four-part fractures with the head in the axilla and medially displaced shaft fractures Doppler studies or arteriography should be considered if there is
- Extreme displacement of the shaft
- Axillary position of the dislocated head
- Large hematoma
- Brachial plexus injury that could indicate trauma to the medial structures.
Opinion of the vascular surgeon should be taught and if required vascular team should be present in operation theater
Arthritis
Could occur following avascular necrosis or hardware penetrating joint. Humeral head or total shoulder replacement may be considered
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