Typically, when your surgeon talks about shoulder fractures, they are talking about a fracture of the proximal humerus (upper arm bone) and the ball and socket of the shoulder.
Fractures of the proximal humerus can be classified into different parts depending on how the bone was broken. This “part” classification is essential in determining what kind of surgery will be done.
Most proximal humerus fractures can be treated without surgery, but if you are having surgery, here is what you might expect.
The surgery typically is a one to two day hospitalization procedure. Sometimes if we are doing things through a very small incision, the surgery will be done as an outpatient.
You will receive a general anesthetic, in addition to a nerve block to your operative side. The nerve block is placed by the anesthesia service and allows you to wake up relatively pain-free. The block lasts for approximately 12-18 hours, after which you can start easing into your pain medication.
You are positioned into a “beach chair” position, with all of your extremities carefully padded. Your head is also supported in a padded head holder. After performing a “time out”, where we verify the operative site, your arm is cleaned and sterilely draped. Typically we make an incision in the front of the shoulder from the end of the clavicle bone down to the bottom of your pectoralis tendon (basically just above the arm pit area).
We can spread most of the tissues and tendons so that we are looking directly at the fracture site. Sometimes we can fix the fracture with suture, and sometimes we need to use a plate and screw for fixation. There are other times that the fracture is so bad, that we use a shoulder replacement (i.e. artificial shoulder). Your surgeon will let you know the plan and any possibilities PRIOR to the surgery.
Once the fracture is fixed, the incision is closed and a sterile dressing is applied. Occasionally we use a drain in the shoulder to help remove some of the swelling, especially if there was a large fracture or if you are staying over night. The drain is typically removed the next day. Your arm is placed in a sling and pillow device for immobilization. It is very important that you stay in the sling and pillow and adhere to the rehabilitation protocol.
Sometimes we move the shoulder very quickly after the procedure, but other times we keep you in the sling for a couple of weeks prior to even moving the shoulder. This will be explained to you after the procedure and very specific instructions will be given to you and your therapist.
Once your pain is under control, you are eating and keeping food down, and you are medically stable, you can be discharged home. You will get a full set of instructions of Do’s and Don’ts. Basically make sure to keep your incision clean and dry. No showering until your postoperative visit. If you have any questions on what you should be doing or not doing to your shoulder, make sure to ask your surgeon or the nurses/residents. You will be seen in the office for a check up and to remove any staples or sutures in 7 – 10 days after surgery. You will also be given a pain medication prescription. Please take the pain medication as directed. Eat a healthy diet and get plenty of rest. Also remember that ICE is a form of pain relief and you should ice the shoulder regularly.
Typically you are in the sling for 6 weeks after surgery but are coming out of the sling for very prescribed movements that you will be taught. Physical therapy is an important part of the rehabilitation but depending on how bad the fracture is, your therapy may be delayed so your bone can heal.
We hope this provides a bit more insight into your surgical procedure for shoulder fractures. As always, if you have any questions, please contact us or call our office at 248-988-8085.