Patient Information Resources

Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

View Web RX

« Back

Okay, I am typing this one-handed because my left arm is in a sling with a broken humerus bone. Despite the name (humerus), I find nothing funny about my situation. It's a good thing I am right-handed so I can ask this question. Should I have the surgery to fix the break or get a shoulder replacement? Or should I go with a trial period without surgery? The surgeon says with a nonoperative plan, I can always change my mind and have the surgery later.

Proximal humeral fractures refers to a break in the upper arm bone close to the top (but below the round head that fits into the shoulder socket). There are no clinical practice guidelines for surgeons to refer to (based on evidence that shows what works best for this problem). Many older adults with this type of fracture developed the problem because of another condition: osteoporosis (brittle bones). Treatment was approached conservatively because of the risks associated with surgery in this age group and also the high number of patients with low bone density associated with osteoporosis. Weak bones can't support metal plates or other fixation devices normally used to stabilize the fracture until it heals. But over time, new technology has brought a device called locking plates that make it possible to repair broken osteoporotic bones. The availability of alternate surgical approaches has opened up new avenues of treatment for many patients who would have otherwise been put in a sling and had to wait it out to see if the arm would heal on its own. More surgeons have the expertise and training to offer patients this type of surgical treatment. Without specific criteria to show who would have the best results with conservative (nonoperative) care versus surgical repair, surgeons and patients are left on their own to make the best decision they can with the information at hand. The surgeon and the patient discuss risks and benefits, patient factors, and surgeon preferences when forming a plan of care. That sounds all very simple but, in fact, there are some complicating factors to consider. First of all, proximal humeral fractures can't just be put in a cast like fractures in other locations. Hospitalization, surgery, and rehab are commonly required. Treatment varies depending on whether the fracture has displaced (separated and shifted apart). And even when surgery is indicated, the type of surgery differs from case-to-case. The basic surgical options include percutaneous fixation (inserting pins or screws through small incisions in the skin), open reduction and internal fixation (ORIF), and arthroplasty (shoulder replacement). ORIF involves an open incision and the use of various hardware devices such as plates (including the new locking plates), pins, and/or screws. Your surgeon is in a position to make recommendations for you based on your individual circumstances. Having this information may help you see the possibilities for future treatment should conservative care fail to yield the results you had hoped for.


« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.