My 92 year old mother in law has broken her humerus near her shoulder badly. The ball has separated from the shaft and since being in hospital the injury seems to have worsened with the ball becoming separated from the socket and out of alignment with the bone. We would like to know what options are available. What will happen if no intervention is made? Are there surgical options for someone in their 90s?
Surgery for surgical neck fractures of the humerus are usually not needed. In this region of the humerus, quite a large amount of angulation and offset can be accepted. The shoulder has such a large possible range of motion, that the angulation/offset can be compensated for easily.
As to surgery for anything, that is dependent upon the overall health status of the patient. Since this is a closed injury, in a region that does not require exacting reduction, surgery would probably not be considered.
It is not uncommon for the ball to sublux in the socket in these injuries. The pull of the rotator cuff muscles help to keep the ball reduced in the glenoid, but when there has been an injury, the patient does not contract the muscle, because it is uncomfortable. As such, the joint tends to sublux.
As the bone heals and the discomfort decreases, the joint should return to its normal status.
Even in osteoporotic bone, fractures will heal. Osteoporotic bone is normal in the mineral that of supposed to be there, it is just decreased in mass and density. So, fractures will heal.
However, the elderly often do not consume a great diet and lack the protein needed to heal an injury. It is important that your mother in law eat extra protein, calcium, vitamin D, and magnesium to help the bone unite.
If however, the humeral head is not completely dislocated from the glenoid, then something may have to be done. But, again, that is dependent upon her overall health status. It is better to be alive with a shoulder that is not 100%, than the other option. But, again, these injuries usually do not need surgical intervention.
Thank you so much for your prompt and helpful reply. Much of what you say is reassuring, though we cannot help being concerned because of the extent of the displacement and the fact that it seems to have got worse not better during two weeks hospitalisation. The X rays we have show the ball seemingly completely dislocated from the glenoid when it was not before, and the shaft alongside it, rather than underneath it. (I would have pasted them into this post if I knew how.)
Yes, I have not been able to figure out how to post images either. It is possible, because I have seen it done. But, I can't figure it out.
As to your mother in law's shoulder, again, it is not uncommon for the joint to sublux a week or so after the injury. Initially there is usually a lot of spasm that helps hold the humeral head reduced. With time, these muscles relax and because of the pain, do not contract to hold the head in place. This should correct itself as time progresses.
As to the alignment, that much displacement would probably not be acceptable in a young patient. Again, overall health status has to be taken into consideration when developing a treatment plan.
If you are concerned about the status of your mother in law's proximal humerus, speak with her orthopedic surgeon. Have him/her go over the x-rays with you, explaining what is going on. Discuss the possible treatment options, including the risk/complications to benefit ratios, and what possible outcomes would be for each.
It is possible that the surgeon has opted to not do any invasive procedures, due to the patient's health status. He/she may feel that the risk of death on the table is too great. Of course, that would result in a shoulder that would not work very well. If you are not comfortable with this, is that is indeed what is going on, you need to discuss it with the surgeon, and soon. You do have a certain window of time for treatment. while reconstructions can be attempted late, there is a window for treatment in the acute stage.
So, speak with her surgeon, so that you understand what is going on and the rationale behind it.