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Abstract: The patient in this case was a 61-year-old female who was riding an electric bicycle and collided with a small car in a car accident, landed on her right shoulder, and subsequently developed severe pain and limited movement in her right shoulder. The strong external force caused the patient to fracture her right humeral head, a common shoulder injury. After admission, the patient was given surgical treatment, medication and functional exercise. The fracture gradually healed and the right shoulder joint function was restored.
Basic information】Female, 61 years old
Disease Type】Comminuted fracture of the right humeral head
Hospital】Liaocheng Second People’s Hospital
Consultation time】May 2022
Treatment plan】Physical therapy (local ice) + surgical treatment (fracture incision and internal fixation surgery) + topical medication (flurbiprofen gel paste) + oral medication (hepaticoside sodium tablets, cefuroxime capsules) + functional exercise
Treatment period】Inpatient treatment for 16 days, outpatient follow-up for 1 and 3 months after discharge
Treatment effect】Fracture healing, right shoulder function recovery
I. Initial consultation
At around 12:00 noon one day in May 2022, 61-year-old Zhou was rushed to the emergency department of our hospital by 120, and was asked to consult our department. The patient was lying on the cart, and the right shoulder was obviously swollen and deformed. Moving the patient’s right shoulder joint caused severe pain, and local bone rubbing sensation and abnormal activity could be palpated. The X-ray findings were explained to the patient and family, and they were informed of the treatment options available to them, conservative treatment or surgery. The patient wanted to have early shoulder movement and had a high demand for shoulder function, so he decided to undergo surgery after discussion with his family.
II. Treatment history
After admission, the patient was given local ice packs on the right shoulder, while he was given heptaerythroside sodium tablets to reduce swelling and topical flurbiprofen gel paste to relieve pain. On the second day after admission, laboratory tests such as routine blood tests, coagulation six items, and preoperative four items were performed, and the patient was actively prepared for surgery. The patient’s various tests were basically normal, so on the third day after admission, the patient was given surgical treatment, under brachial plexus anesthesia, to perform an anatomical locking titanium plate internal fixation of the proximal humerus with fracture dissection. Cefuroxime capsules were administered orally 24 hours after surgery to prevent infection, and the patient was instructed to actively practice flexion and extension of the right elbow joint and fingers of the right hand 48 hours later, and the patient’s family was instructed to help the patient to passively practice small-amplitude abduction of the right shoulder joint 7 days after surgery, and the patient was discharged 14 days after surgery.
III. Treatment effect
After surgical treatment, the patient’s right humeral head comminuted fracture was well repositioned and fixed, and the patient’s surgical incision healed well and the stitches were removed successfully. One month after discharge from the hospital, the patient reported that the swelling of the right shoulder joint had significantly decreased, the flexion and extension of the right fingers and the right elbow joint had returned to normal, and the passive abduction of the right shoulder joint had basically been restored. The patient was instructed to gradually practice active abduction and forward extension of the right shoulder joint, and to practice movements of the right upper limb. When the patient came to the hospital for review 3 months after discharge, the fracture was basically healed, and the right shoulder joint abduction, forward extension, dorsal extension and activities were basically restored to the pre-injury level, and the patient could do dressing, eating and hair combing by himself.
IV. Notes
The patient was discharged successfully after active treatment, and I am truly happy for her. In this case, it was caused by a traumatic injury, therefore, after discharge, the patient should be specially advised to pay attention to safety in both life and work, as well as to avoid violent impact on the right shoulder area. Rest should be taken until the condition is completely healed, but proper activity is needed to avoid restriction of mobility of the damaged joint. The diet should be light and highly nutritious, and the intake of calcium can be increased to promote fracture healing. After discharge from the hospital, pay attention to regular outpatient review.
V. Personal insight
The possibility of shoulder fracture needs to be considered when there is pain, swelling and limitation of movement after violent trauma to the shoulder, among which humeral head fracture is more common. In this patient, the right humeral head fracture was mainly caused by violent impact. After clarifying the injury, the treatment method should be selected according to the degree of fracture dislocation, comminution and stability, combined with the patient’s age and the functional requirements of the shoulder joint.
This patient has a high demand for shoulder function, so surgical treatment is preferred. The surgical treatment can restore the anatomical structure and stability of the humeral head fracture, and the safe and effective functional exercises of the affected limb can be carried out gradually under the guidance after the operation, which can achieve good therapeutic results.