These are the films of a 77 year old healthy male who fell sustaining this severely displaced proximal humerus fracture. This case demonstrates the importance of proper x-ray positioning. As you can see the first 2 views would suggest that the fracture is really not badly displaced.
This view below demonstrates that the fracture is severely displaced. If left like this, and treated nonoperatively, the fracture would likely not heal. If it did heal (unlikely), function would be severely limited. The physical examination actually revealed that the spike on the humeral shaft was poking directly into the deltoid muscle and the tip of the bone was almost coming through the skin.
After evaluating the patient, we decided to bring him to the operating room for an open surgical repair. Those results are below. The metal anchors seen in the bone are for repair of a tear of the subscapularis tendon encountered at the time of the surgery.
This is a great early result for a severe fracture. He is already starting a home exercise program and his pain is greatly reduced after stabilization of the fracure.
Thanks.
JTM, MD