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I visited a dear friend in the hospital who broke her arm. Fell and landed hard on her side -- broke the upper arm bone into three big chunks. The surgeon pinned it all together to try and save it. What happens if it doesn't work?

Patients with complex shoulder fractures -- ones that break the bones into three or four pieces can present quite a dilemma for the surgeon when it comes to figuring out how to best treat the problem. The main question is: which is better -- open reduction and internal fixation (ORIF) or shoulder replacement? Open reduction and internal fixation (ORIF) refers to making an open incision to repair the bone with a metal plate and screws.The hardware holds everything together until it heals. This procedure is usually reserved for younger adults (under age 60) who are active and healthy. If the fracture fails to heal with an open reduction and internal fixation (ORIF), then it can be converted into a shoulder replacement. Basically, the hardware is removed and the broken pieces replaced with an implant. If a shoulder replacement is needed, there are several to choose from. The three main choices are a hemiarthroplasty, a total joint replacement, or a reverse arthroplasty. A hemiarthroplasty means only one part of the joint is replaced (either the round ball in the socket or the socket). Of course, with a total joint replacement the surgeon removes the head of the humerus and the socket and replaces both with matching component parts. And 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. Hopefully, all will go well for your friend and no further surgery will be needed. But rest assured there are additional options beyond internal hardware for this type of problem.

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