The course
Dr Kenneth Cutbush, with Medartis, organised a course for Australian orthopaedic surgeons on the treatment of proximal humeral fractures, meaning fractures of the upper end of the arm bone near the shoulder.
What a proximal humeral fracture is
The proximal humerus is the upper end of the arm bone, the part that forms the ball of the shoulder joint. Fractures here are among the more common fractures in older people and usually follow a fall onto the side or onto the outstretched arm. In younger people they tend to follow higher energy injuries.
Treatment depends a great deal on the pattern. Many of these fractures are held in reasonable position by the surrounding soft tissues and are managed in a sling with early movement rather than with an operation. Where the fragments have displaced, the options include fixing them with a plate and screws, fixing them with nails or wires, or replacing the joint, which in older patients with poor bone or a damaged rotator cuff is often a reverse shoulder replacement. Individual results vary.
What the course covers
The course covers decision-making in the management of shoulder fractures, which is where most of the difficulty lies: these fractures range from a single crack in good position through to the upper humerus breaking into several fragments, and many are better treated without surgery.
It also includes laboratory sessions in which attending surgeons fix pre-fractured specimens. Each specimen is CT scanned both before and after fixation, so that what was achieved can be compared directly against the fracture pattern that was being addressed. The faculty is drawn from experienced surgeons.
That before and after comparison is the part that makes the format useful. A surgeon can see whether the fragments ended up where they intended, which is difficult to judge from the view available during the procedure itself. Courses of this kind are commonly run in partnership with an implant company, which supplies the plates, screws and instruments used in the laboratory sessions.
Related information
- Our shoulder injuries page
- Our reverse total shoulder replacement page
- Our shoulder anatomy page
- Our post on proximal humeral fractures