A 76-year-old right-handed woman is reviewed in general practice 2 days after tripping on a pavement and falling onto her left shoulder.

Question

A 76-year-old right-handed woman is reviewed in general practice 2 days after tripping on a pavement and falling onto her left shoulder. Emergency-department radiographs show a displaced two-part surgical-neck fracture of the proximal humerus. The humeral head is located, with no head-split component or associated glenohumeral dislocation. She was discharged in a broad-arm sling with regular paracetamol and a fracture-clinic appointment in 6 days. She is concerned that the report says “displaced” and requests urgent surgery because she lives alone and wants to regain independence quickly. The skin is intact without tenting. There is no open wound, increasing swelling, or compartment concern. The hand is warm and well perfused, with normal radial pulse, capillary refill, power and sensation. There is no new breathlessness, chest pain or neck pain. What is the most appropriate management plan?

Accepted Answer

Continue non-surgical management in the sling with analgesia and planned fracture-clinic follow-up

Answer

Arrange same-day orthopaedic assessment for surgery because this is a proximal humeral fracture of the dominant upper limb

Answer

Arrange same-day orthopaedic assessment for fixation because radiographic displacement requires operative treatment

Answer

Stop sling use and refer directly for urgent community physiotherapy to restore movement

Answer

Arrange same-day orthopaedic assessment for shoulder arthroplasty because she is older than 70 years

Uncomplicated displaced low-energy proximal humerus fracture — MSRA MCQ