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

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We are facing a crucial decision quickly for our father. He needs surgery for a bad shoulder fracture. We've been told there are two basic options: repair or replace. Repair means the surgeon will piece everything back together and hold it together with a metal plate and as many screws as are needed. Replace means a total shoulder joint. Which way should we go?

Medicine has taken a decided turn toward demanding evidence that a treatment technique or approach is the right one to choose for each problem. Evidence-based medicine also addresses the specific needs of each patient who happen to have that problem. But what should be done when there isn't enough evidence to know which way to go? And when there is more than one way to go? That's the dilemma facing surgeons treating patients with complex shoulder fractures -- ones that break the bones into three or four pieces. The question is: which works better -- open reduction and internal fixation (ORIF) or shoulder replacement? The decision may require some additional information. For example, is the neck of the humerus (upper arm bone) displaced? Displacement means the fracture has separated and shifted apart. Is there good bone quality and good blood supply? Any nerve damage as a result of the displacement of bone (jagged edges can sometimes cut into nearby tissues)? Open-reduction and internal fixation (ORIF) is preferred for younger, active, healthy patients. But the surgeon must be able to reduce the fracture (put it back together and hold it there). If the gap between the pieces of bone is too much for the body to fill in on its own, bone grafting may be used. Otherwise, it may be necessary to go to Plan B (replace instead of repair). Anyone under the age of 60 should at least be considered for ORIF as part of Plan A (repair as the first line of treatment). Older adults (especially over age 80) and anyone with a degenerated or previously torn rotator cuff may be a better candidate for a reverse arthroplasty. A reverse arthroplasty describes an implant with a ball-shaped head where the socket used to be and an artificial socket where the round head of the humerus (upper arm bone) was once located. Age isn't the only cut-off used when choosing between ORIF and arthroplasty. There are many potential patient factors that must be taken into consideration. For example, patient age, health, blood supply to the shoulder, bone health, and joint mechanics are all important pieces of the picture. The final decision will depend on the patient's health, personal goals, and preferences. The surgeon can offer advice based on past experiences with other similar cases.


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