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Our 77-year-old mother dislocated and fractured (or maybe it was the other way around: fractured and dislocated) her upper arm/shoulder area. I saw the X-ray. It looked pretty messy. She's in surgery right now. What can they do for this kind of injury? I'm worried she'll lose her arm.

Most of the time, a patient with three-or four-part fractures of the humeral bone will need surgery to either repair the damage or remove and replace the humeral head. In the case of repair, one effective technique is with a piece of hardware called locked plates. Open incision surgery is required to realign the bone fragments and then screw them together and hold them in place. That's where the locked plates come into play to hold and support the bone until healing takes place. The surgeon may need to use a bone graft and realign the rotator cuff to prevent loss of motion. Choosing the right implant design and placing the implant at the correct angle and height are additional key factors in a good outcome and patient satisfaction. When it is not possible to save the humeral head, the surgeon can remove and replace just the humeral head (a procedure called hemiarthroplasty). Patients who are medically stable are the best candidates for hemiarthroplasty. It is useful when the fracture cannot be reduced and/or when the shoulder cannot be lined up properly. Poor bone quality may also prevent the use of locking plates thus making replacement the only reasonable choice. Older patients (70 years old or older) with poor bone quality are most likely to be treated with a reverse total shoulder arthroplasty (RTSA). Their inability to participate in a rehab program makes the more stable RTSA necessary. Damage or disruption of the blood vessels to the humeral head can further complicate treatment. Without enough blood to the area, the bone can die, a process called osteonecrosis. Preserving or restoring blood supply becomes a critical goal of treatment. But there isn't much danger of losing the arm from this type of injury. Your mother will probably be in a sling for a few weeks and under the care of a physical therapist to help regain motion and strength. Recovery can take quite a bit of time in the older adult (up to a year or more) but she should be able to take care of herself and her daily chores as well as return to any community involvement she may have going.

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