61 yo female with left shoulder pain from a fall 3 days ago. X-ray today shows acute comminuted mildly impacted left humeral neck fracture and mildly displaced greater tuberosity fracture. Please see attached xrays.
Is this something which needs ortho f/u? She is extremely concerned about cost and would prefer to have us manage it here, but I am not sure if this would normally be a surgical case considering she has 2 separate fractures.
Can definitely be treated without surgery. Would recommend sling for 6 weeks with no active motion of the shoulder at this time, however, can have passive and active assisted ROM up to 90 degrees of forward elevation and 30 degrees of external rotation. After 6 weeks, can come out of sling for active ROM as tolerated, but no lifting more than 1-2 pounds/cup of water or coffee. After 12 weeks can begin lifting things/strengthening as tolerated. Would recommend PT to help with this. XRx at 2, 6, and 12 weeks post injury to make sure there is no displacement.
PCP follow up
Here are X-rays done at 6.5 weeks after injury. She has started PT to work on some gradual ROM as per your recommendations. Pain is still significant, needs narcotics for pain control. In your opinion do you think this is still non-surgical? She is very resistant to seeing an ortho to keep the cost down, but I am nervous about the amount of displacement I see in the X-ray. Thank you!
Specialist follow up
Thank you for the pictures. Yes, this can continue to be treated nonoperatively. You can let her know that the shoulder will never return to 100% function no matter what is done, but surgery would be unlikely to improve her outcomes. The rehab program I discussed above can still be utilized. I would encourage her to get off the pain medicine as soon as possible. I usually only treat these fractures with pain medicine for a couple of weeks after the injury.