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As with humeral shaft fractures, these are commonly treated non-operatively. They are more common in elderly patients with osteoporotic bone.
- Check for other injuries in the same limb and elsewhere.
- Check for neurovascular compromise.
Classification
- this is dependent on the number of major fragments
A PART is only considered displaced if it is translated 1 cm or angulated 45?. Many fractures are impacted and do extremely well with conservative measures.
When assessing these fractures consider
- Is it open? – Definitely needs surgery
- Is there a concurrent glenohumeral dislocation? – will likely need closed/open reduction under GA unless it is just a greater tuberosity fracture associated with an anterior dislocation (see above)
- Age of patient? – less inclined to operate in older patients due to poor bone, stiffness, risk of GA, etc.
- Can you move the arm as a unit or does it move at the fracture site? (Use gentle, passive movement to assess this!). If it moves as a unit it is stable and can be treated non-operatively.
Treatment
- Simple sling – for stabl, impacted fractures.
- Velpeau – for better pain control, tuberosity fractures and post reduction of dislocations.
- Sugar Tong – provides extra pain control in some cases but does not control fracture.
- Surgery – for open fractures, those with vascular compromise, and where an unacceptable position cannot be held with conservative measures.
