Conservative Treatment for Elderly Patients with Shoulder Fractures - Orthopedics

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When dealing with shoulder fractures in elderly patients, particularly those with additional health complications such as hypertension, diabetes, and a history of heart disease, conservative treatment is often the preferred approach. In your case, the patient has sustained a complex injury involving both the clavicle and scapula, and the decision to avoid surgery is understandable given the risks associated with anesthesia and surgical intervention in older adults.

1. Future Shoulder Function Without Surgery: If the decision is made to continue with conservative treatment, the prognosis for shoulder function largely depends on the nature of the fractures and the patient’s overall health. Given that the fracture has a significant angulation, there is a possibility that the bones may not heal in the correct alignment, leading to a condition known as malunion. This can result in chronic pain, limited range of motion, and functional impairment of the shoulder. The patient may experience difficulties with daily activities, such as reaching overhead or lifting objects, which can significantly impact their quality of life.

2. Timing for Rehabilitation: Rehabilitation should ideally begin as soon as the acute pain subsides and the patient is cleared by their physician. In many cases, gentle range-of-motion exercises can be initiated even while the patient is in a sling, as long as they do not exacerbate pain or cause further injury. Typically, physical therapy can start around 4 to 6 weeks post-injury, but this can vary based on the individual’s healing process and the physician’s recommendations. It is crucial to monitor the patient’s pain levels and functional abilities throughout this process.

3. Surgical Intervention After 60 Days: If surgery is considered after a delay of 60 days, the healing process may be more complicated. Delayed surgery can lead to the development of scar tissue and stiffness in the shoulder joint, which can hinder recovery. The outcomes may not be as favorable as if surgery had been performed earlier, especially if the bones have not healed properly. However, surgical options such as internal fixation can still be beneficial in restoring function, but the rehabilitation process may take longer and require more intensive therapy.

4. Non-removable Plates: There are surgical options that utilize plates and screws that do not require removal after healing. These are often made from materials that can remain in the body without causing issues. However, the decision to use such implants should be made in consultation with an orthopedic surgeon, who can provide insights based on the specific fracture type and the patient’s overall health.

In conclusion, while conservative treatment can be effective, it is essential to closely monitor the patient’s progress and be vigilant for any signs of complications. Regular follow-ups with the orthopedic specialist are crucial to assess healing and determine the appropriate time to initiate rehabilitation. If surgery becomes necessary, discussing the options for fixation devices that do not require removal can help alleviate some concerns about future procedures. Ultimately, the goal is to restore as much function as possible while considering the patient’s overall health and quality of life.