Asavanapakas Panpaporn, Klabklay Prapakorn, Maliwankul Korakot, Chuaychoosakoon Chaiwat
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Ann Med Surg (Lond). 2023 Apr 1;85(5):1987-1990. doi: 10.1097/MS9.0000000000000527. eCollection 2023 May.
The authors report a case of an elderly female with a displaced varus misalignment of a proximal humerus fracture which met the indications for surgery, but the patient was treated conservatively with an arm sling due to the wishes of the patient and her relatives. The clinical outcome was nearly full function compared with the right shoulder.
A 65-year-old Thai female presented with right shoulder pain 1 h after a fall during which her right shoulder hit the floor. Radiographs of the right shoulder in anteroposterior and lateral transcapular views showed a proximal humerus fracture with varus misalignment. The patient and her relatives decided on conservative treatment with an arm sling. At 12 weeks following the fall she was able to move her right shoulder nearly equally to the left shoulder.
The authors discussed the treatment options with the patient and her relatives and recommended open reduction and internal fixation with a locking plate and screw, but they decided on conservative treatment with an arm sling. At 12 weeks following the fall she was able to move her right shoulder nearly equally to the left shoulder. She had no pain and could do normal life activities with the right shoulder.
Patients with severe varus deformity are usually treated with surgery. If there are contraindications for surgery, the stability of the fracture should first be evaluated through radiographs of the fracture in various arm positions.
作者报告了一例老年女性近端肱骨骨折伴有内翻移位的病例，该病例符合手术指征，但由于患者及其亲属的意愿，患者采用手臂吊带进行保守治疗。与右肩相比，临床结果几乎完全恢复功能。
一名65岁的泰国女性在摔倒后1小时出现右肩疼痛，摔倒时右肩着地。右肩前后位和经肩胛侧位X线片显示近端肱骨骨折伴内翻移位。患者及其亲属决定采用手臂吊带进行保守治疗。摔倒后12周，她右肩的活动能力几乎与左肩相同。
作者与患者及其亲属讨论了治疗方案，并建议采用锁定钢板和螺钉进行切开复位内固定，但他们决定采用手臂吊带进行保守治疗。摔倒后12周，她右肩的活动能力几乎与左肩相同。她没有疼痛，右肩能够进行正常的生活活动。
严重内翻畸形的患者通常采用手术治疗。如果存在手术禁忌证，应首先通过在不同手臂位置拍摄的骨折X线片评估骨折的稳定性。
