Our wonderful Poppie (father and grandfather) took a bad spill over the weekend. He broke the upper part of his arm but ended up with a replacement of the entire shoulder. We're still wondering if it was really necessary to do that much surgery. He's a pretty healthy, active guy.
There are many factors that go into the decision to repair or replace a broken shoulder. Patient age, general health, mental status, and ability to survive surgery head up the list. But type of fracture and condition of the bones are important, too.
The fracture pattern is another important considerations -- especially when the surgeon is forming the plan of care. X-rays and CT scans help show the extent of damage. Surgeons use the results of these imaging studies to classify fractures.
There are two commonly used classification systems. The Neer classification looks at the number of broken pieces of bone that have shifted away by more than one centimeter or that angle more than 45 degrees from their normal location. The AO-ASIF classification looks at how much of the shoulder joint surface is involved.
Both systems help predict the risk of osteonecrosis (bone death) from lack of blood supply. If the risk is too great, then surgery to replace the bone is done instead of trying to save it. Shoulder replacement may be complete (both sides of the joint removed and replaced) or a hemiarthroplasty (just one side is replaced).
The decision to replace part or all of the shoulder isn't easy. The patient must have good enough bone to support the implant. They must be strong enough to have major surgery and then go through rehab. Talk to the surgeon to understand more about why your family member ended up with a shoulder replacement. There was probably more than one reason the natural joint couldn't be saved.
James E. Voos, MD, et al. Arthroplasty for Fractures of the Proximal Part of the Humerus. In The Journal of Bone & Joint Surgery. June 2010. Vol. 92-A. No. 6. Pp. 1560-1567.
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